Virechana vasti amavata-pk017-gdg

“A Comparative Study of Virechana karma and Basti karma in Amavata W.S.R.T. Rheumatoid

Arthritis”

By Suresh N. Hakkandi

Dissertation Submitted to the Rajiv Gandhi University Of Health Sciences, Karnataka, Bangalore.

In partial fulfillment of the requirements for the degree of

AYURVEDA VACHASPATHI M.D. (PANCHAKARMA) In

PANCHAKARMA

Under the guidance of

Dr. G. Purushothamacharyulu,

M.D. (Ayu) And co-guidance of

Dr. Shashidhar.H. Doddamani,

M.D. (Ayu)

Post graduate department of Panchakarma, Shri D. G. Melmalagi Ayurvedic Medical College,

Gadag – 582103.

2006.

Ayurmitra

TAyComprehended

Rajiv Gandhi University Of Health Sciences, Karnataka, Bangalore.

DECLARATION BY THE CANDIDATE

hereby declare that this dissertation / thesis entitled “A Comparative

Study of Virechana karma and Basti karma in Amavata W.S.R.T. Rheumatoid Arthriyis”

is a bonafide and genuine research work carried out by me under the guidance

of Dr. G. Purushothamacharyulu, M.D. (Ayu), Professor and H.O.D, Post-

graduate department of Panchakarma and co-guidance of Dr. Shashidhar. H.

Doddamani, M.D.(Ayu), Assistant Professor, Post graduate department of

Panchakarma.

Date: Suresh N. Hakkandi Place: Gadag.

CERTIFICATE BY THE GUIDE

This is to certify that the dissertation entitled “A Comparative

Study of Virechana karma and Basti karma in Amavata W.S.R.T.

Rheumatoid Arthritis” is a bonafide research work done by Suresh N.

Hakkandi in partial fulfillment of the requirement for the degree of Ayurveda

Vachaspathi. M.D. (Panchakarma).

Date:

Place: Gadag Dr.G.Purushothamacharyulu, M.D. (Ayu).

Professor & H.O.D

Post graduate department of Panchakarma.

ENDORSEMENT BY THE H.O.D AND PRINCIPAL OF THE INSTITUTION

This is to certify that the dissertation entitled “A Comparative

Study of Virechana karma and Basti karma in Amavata W.S.R.T.

Rheumatoid Arthritis” is a bonafide research work done by Suresh N.

Hakkandi under the guidance of Dr.G. Purushothamacharyulu, M.D. (Ayu),

Professor and H.O.D, Postgraduate department of Panchakarma and co-guidance

of Dr. Shashidhar.H. Doddamani, M.D. (Ayu), Assistant Professor, Post graduate

department of Panchakarma.

Dr. G. Purushothamacharyulu, M.D. (Ayu) Dr. G. B. Patil.

Professor & H.O.D, Principal.

Post graduate department of Panchakarma.

COPYRIGHT

Declaration by the candidate

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

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

dissertation / thesis in print or electronic format for academic / research

purpose.

Date: Suresh N. Hakkandi Place: Gadag.

© Rajiv Gandhi University of Health Sciences, Karnataka.

Abstract

Virechanakarma and Bastikarma are the most important among the

Panchakarmas. It has already been proved that the karmas are beneficial in managing

the Amavata, and it is the most common joint disorder worldwide.

The study “A Comparative Study of Virechana karma and Basti karma in

Amavata W.S.R.T. Rheumatoid Arthritis” is focused on important techniques i.e.

Nittyavirechana and Yogabasti and also common clinical entity Amavata.

Nittyavirechana with Eranda tial and Yogabasti with Erandamooladi niruha and

Brihatsandhavadi anuvasana are believed to have a appreciable role in the

management of such crippling nature, reptitive attacks and chronic course of

Amavata.

The objectives of this study are 1] To evaluate the effect of Nittyavirechana in

Amavata 2) To evaluate the additive efficacy of Yogabasti in Amavata3) To evaluate

the comparative effect of Nittyavirechana and Yogabastib in Amavata

The aim of this study was to find out the effect of Nittyavirechana and

Yogabasti in the management of Amavata, and to check the comparative effect in

managing the same disease. Therefore, two groups were made and the results obtained

in both the individual groups were compared. The study design selected for the

present study was prospective comparative clinical trial.

In group A (Nittyavirechana) 01 patients (6.66%) had good response to the

treatment and 11 patients (73.33%) had moderate response to the treatment and

03(20%) patients show mild response after the treament.

In group B (Yogabasti) 6 patients (40%) had good response to the treatment

and 9 patients (60%) had moderate response to the treatment. Among the group A and

B the parameters Gulph, Pada and Uru shows highly significant, where as other

parameters are not significant in the comparative study (By using unpaired t-test,

p<0.05).

At the same time overall treatment response was better in the Nittyavirechana

and Yogabasti. This suggests that there was considerable improvement in both the

groups but Yogabasti group got more beneficial effects.

Amavata is a Kapkavata vyadhi affecting people in the Madhyama avasta. The

disease is obtained by the involvement of Ama and Vata, characterized by Ruja and

Shotha in Sandhi sthanas. Therefore, the agents/therapies of Amapachana, Lekhana,

Vatanulomana etc, properties should be used in this disease. Nittyavirechana imparts

Agnideepana, Vatanulomana and opens up the srotas in the shareera facilitating more

nourishment and free movement of Vata dosha. Yogabasti is prime treatment for

Amavata in turn plays vital role in correcting pathology of the disease and gives

remarkable results.

This results in the relief of symptomatology of the disease, by acting locally

and systematically. Ingredients of Eramdamooladi niruhabasti and Brihatsaindhavadi

tail possess properties such as Vedanashamaka, Shotahara Lekhana and also

Vatanulomaka. There by, it is an ideal treatment of choice in Amavata.

Key words: - Nittyavirechana, Yogabasti, Amavata, Rheumatoid Arthritis,

Vaishwanara choorna Eranda tail, Eeandamooladi niruha, Brihatsaindhavadi

anuvasana.

Acknowledgement One of the great pleasure of life is doing the things that others says you

cannot do it, by the grace of god, bless of eiders I take this opportunity to express my

regards to the persons who helped in completing this work.

I express my deep sense of gratitude to his great holiness Jagadguru Shri

Abhinava Gavisiddheshwara mahaswamiji for their divine blessings.

Words fail miserably when I try to express my gratitude to my mentor, my

guide Dr.G.PurushottamacharyluM.D(Ayu), H.O.D of P.G.Department of

Panchakarma. For his incessant, untiring, round the clock guidance with all the

diligence. His sustained fostering and encouragement instilled considerable

impetus in me enabling to achieve this milestone which otherwise would have

lacked this particular finish.

Indeed, I will cherish the affectionate guidance of my co-guide

Dr.Shashidhar H.Doddamani M.D (Ayu), Asst professor of P.G.Department of

Panchakarm. For his invincible and radical thinking were very valuable in

achieving this research work invoking scientific spirit throughout the course of the

study.

I express my sincere and deep gratitude to Dr.G.B.Patil, Principal,

D.G.M.A.M.C, Gadag, for his wholehearted encouragement as well as providing all

necessary facilities for this research work.

I express my sincere gratitude to Dr.P.Shivaramudu M.D (Ayu), Assistant

Professor and Dr. Santhosh.N.Belavadi MD (Ayu), Lecturer of P.G.Department of

Panchakarma for his excellent advices.

I also express my sincere gratitude to Dr.S.D.Yargeri R.M.O. for his moral

support and special care in providing the all the facilities during this trail work.

I express my sincere gratitude to Dr.V.Varadacharyulu, Dr.M.C.Patil, Dr.

Mulgund, Dr.Dilip Kumar, Dr.R.V.Shetter, Dr. K.S.R.Prasad, Dr.G.Danappa Gowdar,

Dr. Kuber Sankh, Dr.J.G.Mitti, Dr.Sheshikanath.Nidagundi, Dr. Samudri and other

PG staff for their constant encouragement.

I thank Dr. B. G. Swami, Dr.U.V.Purad, Dr.B.M,Mulkipatil and other

undergraduate teachers for their support in the clinical work. I thank to Shri.

Nandakumar (Statistician), Shri.V.M.Mundinamani (Librarian), Mr.Surebana and

other hospital and office staff for their kind support during my study.

Indeed, I will cherish the affectionate of my Father, my Mother, my wife

Dr. Pratibha, my son Satvika, my sister Jayashree, brother-in-law Sharanappa, my

brother Shambanna Bavihalli and all my family members who have been a source of

inspiration for my entire carrier.

I cardinally thank Dr. B. S. Savadi, Dr. Sambayya, Dr. K. B. Hiremath, Dr. A.

S. Patil, Dr. C. S. Karamudi, Dr. S. S. Shiruramath, Dr. Srikant P.L., Dr Rudrakshi,

Dr. S. R. J., Dr. Manohar, Dr. S. M. Patil, Dr. B. V. Desai, Dr. Hunagund, Dr. Syed

Pasha, Raghavendra Kulakarani and other staff of S. J. S. Ay. Medical college

Koppal.

I express my sincere thanks to my friends Dr.Babu Menon, Dr.Dattu Vijapur,

Chandranna M., Ramesh Gadad, Anand Ballary, Dr.Santhosh.L.Y, Dr. Subin, Dr.

Sateesh, Dr. Febin, Dr. Varsha, Dr. D. S. Swami, Dr.V.M.Hugar, Dr.Jayaraj

Basarigidad, Dr.Venkaraddi, Dr.B.L.Kalmath, Dr.P.Chandramouleeswaran,

Dr.Shaila.B. Dr.Uday Kumar, Dr.Ratna Kumar, Dr.Ghanti, Dr.Pradeep, Dr.Sobagin,

Dr.Manjunath.Akki, Dr.G. G. Patil, Dr.Ashwindev, Dr.V.S.Hiremath,

Dr.L.M.Biradar, Dr.Jagadisha.H., Dr.Sharanu, Dr. Krishna J. Dr. Shivakumar Sarvi,

Dr.Anand, Dr.Umesh, Dr.Suvarna, Dr. Anita Dr.Devendrappa, Dr.Sibaprasad,

Dr.Madhushree, Dr.Ashok.M.J, Dr.Payappagoudar, Dr. Prasanna, Dr. Nataraj, Dr.

Udayaganesh, Dr. Adarsha, Dr. Shailej, Dr. Muktha and other post graduate scholars

for their support.

I would like to mention the support and inspiration provided by my Father-in-

law Shri.Shantappa Budihal & family for their support and encouragement during my

study.

I acknowledge my patients for their wholehearted consent to participate in this

clinical trial. I express my thanks to all the persons who have helped me directly and

indirectly with apologies for my inability to identify them individually.

Finally I dedicate this work to my respected parents Shri. N. S. Hakkandi,

Smt. F. N. Hakkandi and my wife Dr. Pratibha who are the prime reasons for all

my success.

Date: Signature of the scholar

Place: (Dr.Suresh N. Hakkandi)

TABLE OF CONTENTS Chapters Page No.

1. Introduction 1-4

2. Objectives 5

3. Review of literature 6-85

4. Methodology 86-104

5. Observation and Results 105-136

6. Discussion 137-154

7. Conclusion 155-156

8. Summary 157-158

9. Bibliography 159-171

10. Annexure

List of tables

Table No. Page No.

1. Showing bhoutik composition of virechana dravya 14 2. Showing doses of Virechana drugs according to Sharangdhara 19 3 showingvirechana matra according Koshta 19 4 showing Assessment parameters of Virechana 20 5 showing Samyak Yoga Lakshana of Virechana 21 6 showing Virechana Vyapat 21 7 Showing Amavata Nidana according to various Acharyas 49 8 Showing the similarity between Amavata and Rheumatoid Arthritis 56 9 showing lakshans According to different Ayurvedic classics 58 10 Showing the Sthananusara Laxana 59 11 showing various Upakramas have been prescribed by different 68

Acharyas for the treatment of Amavata: 12 showing extra articular features of RA 79 13 showing differential diagnosis regarding with Amavata 81 14 Showing the Composition and Properties of Vaishwanara Churna 88 15 Showing the Properties of Drugs of Brihat Saindhavadi Taila 89 16 showing Erandamooladi Vasti Dravyas 91 17 showing distribution of patients by age groups 106 18. Showing distribution of patients by Sex 107

19 showing distribution of patients by religion. 108

20 showing distribution of patients by occupation. 109

21 showing distribution of patients by socio-economical status 110 22 showing distribution of patients by dietary habits. 111

23 showing the distribution of patients by duration of disease 112 24 showing the distribution of patients by treatment history 113 25 showing distribution of patients by nature of Koshta. 114

26 showing distribution of patients by Jatharagni. (Status of Jatharagni). 115

27 showing distribution of patients by nature of Mala pravritti 116 28 showing distribution of patients by type of Desha. (Nature of Habitat). 117

29 showing distribution of patients by Vyasana. (Addiction). 118

30 showing the distribution of patients by Nidra in both Groups. 119 31 showing the distribution of patients by Deha prakriti in both Groups. 120 32 showing the distribution of patients by Satmya. 121

33 Showing the presence of RA factor in both group 122 34 Showing the presence of ASLO titer in both group 123 35 Showing the presence of CRP titer in both group 124 36 Showing the types of Amavata in both groups 125 37 Showing the distribution of patients by Mode of onset in both Groups. 126 38 showing distribution of patients by Nidana 127 39 showing the distribution of symptoms of Amavata in both Groups 128 40 Showing the over all effect of treatment in both Groups. [ last graph] 129

41 showing Data related to the response of treatment in group A 131 42 showing Data related to the response of treatment in group B 132 43 showing statistical analysis of subjective and objective 133

parameters in group A 44 showing statistical analysis of subjective and objective 134 parameters in group B

45 showing the comparative statistical analysis 135 of subjective and objective parameters in both groups

List of graphs 1 showing distribution of patients by age groups 106 2. Showing distribution of patients by Sex 107

3 showing distribution of patients by religion 108

4 showing distribution of patients by occupation 109

5 showing distribution of patients by socio-economical status 110 6 showing distribution of patients by dietary habits. 111

7 showing the distribution of patients by duration of disease 112 8 showing the distribution of patients by treatment history 113 9 showing distribution of patients by nature of Koshta. 114

10 showing distribution of patients by Jatharagni. (Status of Jatharagni). 115

11 showing distribution of patients by nature of Mala pravritti 116 12 showing distribution of patients by type of Desha. (Nature of Habitat). 117

13 showing distribution of patients by Vyasana. (Addiction). 118

14 showing the distribution of patients by Nidra in both Groups. 119 15 showing the distribution of patients by Deha prakriti in both Groups. 120 16 showing the distribution of patients by Satmya. 121

17 Showing the presence of RA factor in both groups 122 18 Showing the presence of ASLO titer in both groups 123 19 Showing the presence of CRP titer in both groups 124 20 Showing the types of Amavata in both groups 125 21 Showing the distribution of patients by Mode of onset in both Groups. 126 22 showing distribution of patients by Nidana 127 23 showing the distribution of symptoms of Amavata in both Groups. 129 24 Showing the over all effect of treatment in both Groups. 130 List of flow chart 1] Flow chart showing Samprapti of Amavata 52 2] Flow chart showing pathogenesis of RA 76

Introduction

Introduction

Ayurveda, the fountain head of Indian medicine was conceived as a

science and preached in this country some thousands of years ago, long before the

other countries could dream of systematizing the concept of the remedies for

human ailments.

With the march of time, most of the dietary habits, social structure, life

style, and environment have been changing. Occurrence of Amavata on large

scale is one of the outcomes of this modification. It is commonest among chronic

inflammatory joint diseases in which joints become swollen, painful, and stiff. It

is a debilitating disease in view of its chronicity and complications. Therefore, it

has taken the foremost place among the joint disorders. It continues to pose

challenge to physician due to severe morbidity and crippling nature and claiming

the maximum loss of human power making it a biggest world wide burning

problem irrespective of races. It is equated with Rheumatoid Arthritis, an

inflammatory Auto-immune disorder.

The lives of more than one million people are physically impaired due to

Rheumatic disorders and one fifth of these are severely disabled. The onset is

more frequent during 4th and 5th decade of life with 80% of patients developing

the disease between the ages of 35 to 50 years. Women are affected

approximately 3 times more often than men. Pregnancy is often associated with

remission of the disease in the last trimester with subsequent relapses after

delivery. About 10% of the patient will have an affected first degree relative. A

genetic susceptibility to altered immune responses probably is important in R.A.

Amavata was first described as an independent disease in Madhava

Nidana. It is a disease of Madhyama Roga Marga as it affects Sandhis and

Hridaya Marma. Though Ama and Vata are the predominant pathogenic factors

A Comparative Study of Virechana karma and Basti karma in Amavata W.S.R.T. Rheumatoid Arthritis

1

Introduction

but the disease represents Tridoshic vitiation. The affliction of Sandhis by Vata

dosha in association with Ama, reflects the equal role of both Dosha and Dushya

in the causation of this disease. Moreover, the chief pathogenic factors, being

contradictory in nature posses difficulty in planning the line of treatment.

No doubt allopathic system of medicine has got an important role to play

in overcoming agony of pain, restricted movement and disability caused by the

articular diseases. Simultaneously prolonged use of allopathic medicines are not

only giving rise to many side effects, toxic symptoms and adverse reactions but

also more serious complications like organic lesions etc. are caused by them.

Hence the management of this disease is merely insufficient in other

systems of medicine and patients are continuously looking with a hope towards

Ayurveda to overcome this challenge.Till now 160 Ph.D and P.G. works have

been carried out at various Ayurvedic Institutions and about 25 Reseach works

have been carried out in P.G. Institutes. This large number itself suggests its large

occurrence and faith of patients in Ayurvedic Management.

For the present study, on Amavata as Shamana therapy Nittyvirechana

with Eranda Taila and Yogabasti with Erandamooladi kwatha niruha and

Bruhatsandhavadi taila anuvasana has been chosen, for the comparative effect of

both. Many works with Virechana Karma and Ksharabasti on Amavata have been

successfully carried out. But evaluate the comparitive effect of the results of

Nittyavirechana and Yogabasti was conducted in this study. Both the therapies

chosen fulfill the regimen of specific treatment of Amavata mentioned in

Chakradatta.

Total 30 patients of Amavata were treated. These patients were randomly

distributed into 2 groups which are 15 patients reciveing Nittyavirechana with

Eranda taila and another 15 patients recived Yogabasti with Erandamooladi


2

Introduction

kwatha niruha and Bruhatsandhavadi taila anuvasana Out of the above said

groups Yogabasti with Erandamooladi kwatha niruha and Bruhatsandhavadi taila

anuvasana provided significantly better improvement in Rogi bala, Agni bala,

Deha bala and Chetasa bala than the other group.

The complete study has been made into two major divisions - the

conceptual study & the clinical study. The conceptual study is grouped into a

literary review of Virechana, Basti Amavata and drug review, the clinical study

contains the Observations, Results, Discussion and Conclusion and lastly

Bibliography.

Need for the study:

The Panchakarma therapy is an integral part of Ayurveda many diseases

according to Ayurveda are direct result of Srotavarodha particularly due to the

Agnimandya and Ama1. Panchakarma play a vital role in Ayurvedic therapeutics.

Shodhana strikes at the root of malas and eradicates them2 and as such

the disorders treated with Samshodhana do not reoccur while those treated

with other methods might reappear.3

Many of the chronic progressive disease like Rheumatoid Arthritis (RA)

do not have an effective line of management, recent studies on RA have

suggested positive results with Panchakarma.

RA is an immuno inflammatory disease that affects joints and extra

articular tissues4. RA occurs throughout the world and in all ethnic groups 5.

The prevalence is highest in Indians. In caucasians it is around 1.0 to 1.5%

with a female : male ratio 3:16. The onset of RA may occur any time in life.

Approximately 70% of RA occurs between the 3rd and 7th decades7.

. The disease draws attention for the consideration of research firstly due

to the gravity of the problem, secondly due to the lack of suitable known


3

Introduction

modern drugs for treatment and lastly it is an intriguing disease and challenge

to clinicians and research workers.

In the management of Amavata Ayurveda gives importance to Shodhana

karma among Shodhana Virechana and Bastikarma have got vital role8 in curing

and preventing the disease.

The present study intends to give new light on the comparative effect of

Virechana and Basti in Amavata so “A comparative study of Virechana karma

and Basti karma in Amavata with special reference to Rheumatoid Arthritis” is

under taken.


4

Objectives

Objectives

The above study was carried out with following Aims and Objects:

1. To study the effect of Nittyavirechana with Eranda taila in Amavata.

2. To evaluate the efficacy of Yogabasti with Erandamooladi kwatha niruha

and Bruhatsandhavadi taila anuvasana in Amavata.

3. To compare the efficacy of above two procuder in Amavata.


5

Historical review

Historical review of Virechana

Ayurveda has propagated treatment for most of the disease, in that

treatment mainly we find two types according to Kayachikitsa Siddhanta, and

those are Shamana and Shodhana. Shamana means mitigating doshas in the body

when they have aggravated, though after mitigating once again they may reoccur,

where as Shodhana procedure is nothing but eliminating the doshas out of the

body. In this there is no chance of reoccur.

Virechana is such a treatment modality, which eliminates doshas from

Guda marga. This Virechana have well explained in Samhita kala and Sangraha

kala.

Samhita kala

1] Charaka samhita;

Explanation of Virechana dravya sangraha, Virechana yogas, its

prosuder,9,10,11 different types of Virechana dravya kalpa in Kalpa sthana,12 in

Siddhi sthana we find fine explanation of Virechana Samyag laxana, Ayoga

laxana, Atiyoga laxana, Virechana yogya, Ayogya, Virechana Vyapat and its

Chikitsa have delt.13,14,15

2] Susruta samhita:

In Susruta samhita Chikitsa sthana the complete procedure of Virechana,

its definition, Samyag laxana, Ayoga laxana, Atiyoga laxana, Virechana yogya,

Ayogya, Virechana Vyapat and its Patikara have completely explained.16,17 In

sutra sthana different virechana dravyas and its preparation is explained.18,19

3] Astanga sangraha:

In the astang sangraha sutra sthana 27th chapter whole Virechana karma

have explained,20 in kalpa sthana Virechana yogas and Vyapats are discussed.21


6

Historical review

4] Astang hridaya:

In the 18th chapter of his Sutra sthana complete Virechana procedure,22 in

his Kalpa sthana Virechana yogas and Vyapats are mentioned.23,24

5] Sangraha kala:

We find well contribution of Virechana in Sharangadhara samhita,25

Kasyapa samhita Siddhi sthana,26 Bhavaprakasha poorva khanda,27 Yogaratnakara

Virechanadhikara28 and Chakradatta Virechanadhikara.29

Historical review of vasti

In the literature it is necessary to know the past events of concerened

subject. From ancient period it self-science of Ayurveda have started. So it is

necessary to know about the systemic documents of Veda, Purana, Yogic

literature and our Ayurvedic text.

1] Veda kala

Direct reference of Vasti karma will not be found in Veda, but

explanation of Vasti is their as “Vishitam te Vastibilam”30

2] Purana kala

Vasti is indicated as the principal remedy in the probleme of increase of

Vatadosha in Agnipurana.31 Different Snehas have told to use for Vasti

accourding to season.32

3] Yogic literature

Gheranda samhita includes Vasti in Satkarma, mainly two types of

Vasti have explained on their besis of administration ie first is Jala vasti which

will be done in water, second one is Sushkavasti which is done on land.

4] Samhita kala

Most of the Ayuevedic classical text have given much importance to Vasti

karma, that’s why we found separate Adhyayas for explaining Vasti karma and


7

Historical review

while dealing the treatment of each disease we will find the elaborate version of

Vasti Dravya and preparation.

Vasti revieve of Samhita can be studied by referring Charaka samhita,

Susruta samhita, Astanga sangraha and Astanga hridaya.

Charaka samhita

Charaka has explained definition of Vasti, Types of Vasti, priparetion of

Vasti, Procuder of Vasti, Karmukata of Vasti, Vasti Vyapat its Chikitsa, Vasti

dravyas etc.33

Susruta samhita

Susruta widely explained definition of Vasti, Types of Vasti, priparetion

of Vasti, Procuder of Vasti, Karmukata of Vasti, Vasti Vyapat its Chikitsa, Vasti

dravyas etc in his Chikitsa sthana.34

Vagbhata

Both in Astanga sangraha35 and Hridaya36 elobarate discription of Vasti

have told in Sutra sthana and regarding Vasti Dravya we will find in Kalpa

sthana.37,38

Kashyapa Samhita:

In Kashyapa Samhita, Basti has been explained in detail in Siddhisthana

and Kalpasthana.39

Bhela Samhita:

In Bhela Samhita, description of Basti is available in four chapters of

Siddhisthana namely Bastimatriya Siddhi, Upakalpa Siddhi, Phalamatra Siddhi

and Dosha Vyapadika Basti Siddhi.40

Harita Samhita:

In this text, only 3rd chapter of Sutrasthana deals with Basti.41


8

Historical review

Chakradatta:

In this text, two chapters named Anuvasanadhikara and Niruhadhikara are

dealt with Anuvasana and Niruha Basti respectively.42

Vangasena:

In Chikitsa Sarasangraha, Vangasena has devoted “Basti Karmadhikara”

chapter for description of Basti.

Sharangadhara Samhita:

Three chapters of Uttarakhanda namely Basti Kalpana Vidhi, Niruha

Basti Kalpana Vidhi and Uttara Basti Kalpana Vidhi described various aspects of

Anuvasana Basti, Niruha Basti and Uttara Basti respectively.43, 44,45

Bhavaprakasha:

In this Grantha, 5th chapter of Purvakhanda has been contributed to the

description of Basti. Vrana Basti – this type of Basti has been explained in this

Grantha.46

Kalyanakaraka: In this text, Basti is described in Vatarogadhikara only.

Todarananda: In this text, Basti is described in the chapter Basti Vidhi.

Historical review of Amavata

An off shoot of Atharva and Rigveda, this science of medicine is without

beginning, but Ayurveda saw throughout many people, who organized it into

beautifully woven treatises, incorporating newer diseases and their treatment,

which cropped up during their times. It is evident in the Samhitas that the most

prevalent and deadly diseases have been devoted separate chapters were included

as secondary diseases under the major category.


9

Historical review

Amavata might not have been widely prevalent and severely crippling as it

was during the time of Madhava Nidana, as we see only passing references to the

disease have been made in the Bruhatrayees. Madhava was the first person to

devote separate chapter for Amavata. Thus the birth of this disease and its

formative years can be glanced, starting from Vedic period.

Vedic period (5000 BC to 1000 BC):

Clear cut explanations of Amavata are not available in Vedic Samhitas,

but disease caused by Kapha have been more or less described under the major

heading Balasa, but the diseases of joints are not included here. Sayana has

quoted few references indicating arthritic syndromes, such as-

Rapasi47: Disease arising due to sin (Rigveda) characterized by pain in

multiple joints also referred to as Papa. Yakshma and treatment with Jala, Vayu

Yava, Kushta have been indicated.

Jayanya48: This disease is said to affect the bones cervical vertebrae and

arise from women through Sanga. Whether the disease refers to rheumatoid

arthritis is still not clear.

Grahi49 (Rigveda and Atharvaveda): This has been described as the

disease of joints but characteristic features have not been clearly mentioned.

Treatment of this disease with Dashavruksha has been mentioned.

Vatikrut50: This disease has been described as a serious ailment caused by

Vata and treatment with Pippali and Vishanashaka has been mentioned.

Sandhivikruti51 (Atharvaveda): This disorder is caused by Sleshma and

can be treated with prayers.

Samhita period (1000 BC TO 600 AD):

Charaka Samhita: Charaka has described in detail Ama and Ama

Pradoshaja Vikara and their treatment with Langhana and Ullekhana.52


10

Historical review

Charaka had described treatment for Amavata while dealing with Avarana

Chikitsa in Vatavyadhi, 53 which indicate Pramehahara and Medohara Vidhi.

Amavata finds a mention in the list of therapeutic indication of Kamsa Hareetaki54

in Shwayathu Chikitsa and Vishaladi Phanda in Pandu Chikitsa.55

The treatment of Shariragata Ama in Grahani Chikitsa by Charaka56 is

similar to the description of Amavata Chikitsa by Bhava Mishra i.e. Langhana,

Pachana and oral administration of Panchakola Phanta57, same is the case with

Amavata Chikitsa of Chakrapani in Chakradatta58.

Sushruta Samhita: The description of Amavata in Sushruta Samhita is

conspicuous by its absence.

Bhela Samhita: The tenth chapter in Sutra Sthana deals with Ama Pradosha. This

description has some resemblance with that of Amavata.

Harita Samhita: A complete chapter on Amavata finds a mention in Harita

Samhita59. The classification of Amavata is quite unique and not followed by any

of the later works in this field.

Anjana Nidana: This work is claimed to be written by Acharya Agnivesha,

contains detailed description about etiology, premonitory symptoms, clinical

manifestations and complications.

Sangraha Kala (600AD-1600AD):

Astanga Sangraha and Astanga Hridaya have ignored the disease though

the word Amavata is included in the therapeutic index of compounds Vatsakadi

Yoga60 and Vyoshadi yoga61.

Madhava Nidana62: Madhavakara stated this disease as a separate entity and has

dealt separate chapter.

Chakradutta: Chakrapanidutta has described the treatment for Amavata63.


11

Historical review

Vangasena64 and Vrinda Madhava followed Madhava with few additions

in the treatment aspect. Works like Bhava Prakasha65, Yogaratnakara66 and

Bhaishajya Ratnavali67 have only corroborated the descriptions with additional

principles of treatment.

Adhunika Kala (1600AD onwards):

Mahopadhyaya Acharya Gananath Sen has coined the term Rasavata for

Amavata.

In Yoga Shastra the practice of Shushka Basti for improving Jatharagni

and treating Amavata has been mentioned68. Y.N.Upadhyaya (1955) has corelated

the disease with rheumatoid arthritis. Later research workers have agreed with

Y.N.Upadhyaya.

Modern History of Rheumatoid Arthritis69

First Century AD: The rheumatoid/rheumatology is derived from the root

‘Rheuma’, which refers to a substance that flows and probably was derived from

phlegm, an ancient primary humor, which was believed to originate from brain

and flow to various parts of the body causing ailments.

1642 A.D.: The word rheumatism is introduced into the literature by the French

physician Dr.G.Baillou who emphasized that arthritis could be a systemic

disorder.

1800 A.D.: Landre Baervier a physician from Salta Petruver in Paris seemed to

have described the disease for the first time he called it Gartte Asthanique

Primitivae.

1857 A.D.: Sir Garrod proposed the name Rheumatoid Arthritis, Bannatyne also

in 1959 published his pathological observations on the disease but he could

differentiate it from Osteoarthritis only in his later edition.


12

Historical review

1928 A.D.: The American committee for the control of rheumatism is established

in U.S. by Dr.R.Pemberton, renamed American Association for the study and

control of rheumatic disease (1934), then American Rheumatism Association

(1937) and finally American college of Rheumatology (ACR) (1988).

1940 A.D.: The terms Rheumatology and Rheumatologist are first coined by Drs.

Hollander and Comroe respectively.

1948 A.D.: Roses identified some criteria for diagnosis of RA.

1958 A.D.: American Rheumatic Association suggested uniform criteria for

diagnosis.

1987 A.D.: The criteria were revised.

In the beginning it was thought to be an infective condition especially in

early 20th century. French scientists thought it to be due to tuberculosis.

Hench and Kendell introduced steroids in the management of rheumatoid

arthritis described paediatric onset, juvenile RA in 1896. Later Felty A.R.

described Felty’s syndrome.

Recent advancement in immunology has opened new vistas in the

management of RA. Unfortunately till date the etiology of RA is unknown the

pathogenesis is speculative, the treatment is only palliative and there is no cure to

this disease.


13

Virechana karma

Revive of virechana karma

Virechana is one of the Shodhana karma described by Acharyas. It is a

specific process for elimination of Pitta Dosha, but other two Dosha to some

extent. It is less tedious procedure than Vamana and hence less possibility of

complications, and could be done easily. So Virechana karma is widely practiced

Shodhana therapy in routine.

Definition:

The process of elimination of Dosha from Adhomarga is known as

Virechana 70.

Sometimes actions of expelling Doshas through both Urdhva (Vamana) and

Adhomarga are also termed commonly as Virechana. For instance Caraka has

mentioned Yoga of Vamana and Virechana both. Even for Niruha Basti and

Shodhana Nasya Virechana term is used. But in this context Virechana can be

understood as a procedure-involving intake of medicine through oral route and

expelling vitiated Pitta Dosha and Mala through Adhomarga71.

Pharmacodynamics of Virechana Karma:

The Bhuta predominance as well as the properties of drug should be

analyzed in detail to explain the Pharmacodynamics of the particular drug in

Virechana Karma. Contrary to Vamana Dravya, Virechana Dravya possesses

some properties, which are not in accordance with the Bhautik constitution72.

Table-1, Bhoutik composition of virechana dravya

Bhautik Composition Properties expected Properties present Sneha Ushna Manda Tikshna Sthula Sukshma

Bhumi Jala

Guru Vyavayi

Virechana Dravya has Guna, which are not in accordance with Bhutas,

which may be explained in terms of Vichitra Pratyayarabdhata. This Vichitra


14

Virechana karma

Pratyayarabdhata causes bivalent action of the drug an action in the Shakhas,

which is entirely opposite to the Koshta.

The drugs with properties like Ushna, Tikshna, Vyavayi and Sukshma by

virtue of their penetrative as well as infiltrative properties enter Hridaya and from

there they spread through Dhamanis. These drugs cleanse the adhesive body

Humours by their Agneya Guna and thoroughly disintegrate them by Tikshna

Guna. This brings the Doshas to Amasaya. Proper Snehana and Svedana have

done previously facilitate this process. The circulating metabolic abnormal or

waste products are thus treated by this process and actively excreted to the

intestinal lumen. In the Koshta contrary to the Vamana Dravya, further action

takes place according to the Bhuta predominance and Adhobhaga Prabhava of the

drugs. This bivalent property makes the Virechana drug practically less

complicated and easily employable. Moreover this is the only reason for the

elimination of Dosha through Virechana from Kaphasthana (Amashaya),

Pittasthana (Pachyamanashaya) and Vatasthana (Pakvashaya). But the action of

Vamana is focused in Amashaya only.

Indications and contraindications of virechana karma:

Prior to subjecting the patient to any therapy, it is necessary to examine

whether the patient is fit for proposed therapy or not. Following are the

indications and contra indications for Virechana karma.

Indication:

1. Dosha

Utklishta Pitta, Kapha Samsrshta Pitta, Pittasthanagata Alpa Kapha,

Kaphasthanagata Bahu Pitta73.

Pakvashayagata Pitta or Kapha Pitta74.

Pitta Avrata Vata, Kapha Avrta Vata75.


15

Virechana karma

Caraka advises that Tiryakgata Dosha should be taken back to Koshta,

gradually by proper acts and after that elimination should be carried out. This

denotes that Virechana is the treatment of choice in Tiryakgata Dosha as seen in

Kushta.

2. Dushya

For Rasa, Rakta etc, Vikaras Virechana Karma is described in direct or

indirect way76, 77,78.

3. In Svastha79

4. Purvakarma of Rasayana and Vajikarana 80.

5. Virechana is indicated in disorders like, Gulma – Vatadhikya, Kamala –

Paittika, Gara – Tridoshaja, Unmada –Tridoshaja, Kushta – Tridoshaja etc.

From the above references it becomes clear that Virechana karma has a specific

action on various conditions of all three Doshas. It is a procedure of choice for

healthy as well as diseased person.

Contraindication:

In Classics, Contra indications of Virechana are explained in detail. They

can be summarized in following headings

Incapable to tolerate the stress of therapy like Vilanghita, Durbala, Subhaga,

Navaprasuta etc

Sama Avastha of the disorders like Navapratisyaya, Ajirna, Navajvara

Diseases of rectum like Kshata Guda, Muktanala.

Some conditions like Ratri Jagarita, Atisnigdha, Atiruksha, Bhayoptapta,

Chintaprasakta.

Disorders like Adhoga Raktapitta, Hradroga, Atisara, Rajayakshma, Urusthambha

etc81, 82,83.


16

Virechana karma

Types of virechana

I. According to Mechanism of Action:

Virechana Dravya is several in numbers. According to Caraka, there are 3

types of Virechana Dravya Viz, Trivrt, Aragvadha and SnuhiKshira are

considered as the best Sukha Virechana, Mrdu Virechana and Tikshna Virechana

respectively84.

Acharya Caraka also described Bhedaniya, Virechanopaga and

Anulomana, which are also suggestive of the types of Virechana. But

Sharangadhara has given a specific description regarding the types of

Adhobhagahara karma; they are Anulomana, Sramsana, Bhedana and Rechana85.

II. According to Prayoga Bheda:

Curna, Vati, Asava, Arista, Avaleha, Sneha and Kashaya etc, Virechana

yoga can be administered in this form of preparation.

III. Based on Part of the Dravya used:

Sushruta describes the following drugs with priority for Virechana

Karma86.

Mula Virechana Syama Trivrt

Phala Virechana Haritaki

Taila Virechana Eranda

Svarasa Virechana Karavellaka

Paya Virechana Snuhi.

Caraka also describes in general Virechana drugs like Mulini, Phalini, Lavana and

Kshira etc.

iv. Classification according to quality:

Caraka and Sushruta have used the terms like Snigdha Virechana and

Ruksha Virechana.


17

Virechana karma

Procedure of virechana

For easy understanding purpose whole Virechana procedure can be

grouped under headings like I. Purva Karma II. Pradhana Karma and III. Pascat

Karma

I.Purvakarma:

Purvakarma includes,

Sambhara Samgraha- Collection of all the necessary equipments, drugs, diet etc

used for the therapy.

Atura Pariksha- The detail examination of the Dosha, Dooshya, Atura Bala etc to

be carried out to know fitness of individual to Shodhana87.

Atura Siddhata- Snehana and Svedana are to be carried out prior to Virechana

Karma88. After observing Samyak Snigdha Lakshana by Snehapana, 3 days

Vishrama Kala is given prior to Virechana. During those days Sarvanga

Abhyanga and Bashpa Sveda are performed.

Diet- Snigdha, Ushna, Drava, Mamsarasa, Yusha, Amla Rasa Ahara is preferable

during Vishrama Dina. But Kapha Vardhaka Ahara is to be strictly avoided89.

Manasopacara- Whole procedure of Virechana is to be explained to boost

confidence of the individual.

Matra Vinischaya- Matra should be selected in such a way that the desired effect

of Shodhana may be achieved without any complications. The dose is to be

decided based on Atura, Agni, Koshta and Aushadha.

While describing the process of Virechana the dose mentioned of Trivrta yoga is

one Aksha (1 tola).

However Sharangdhara has given the dose schedule, which seems to be applicable

now a day.


18

Virechana karma

Table-2, Doses of Virechana drugs according to Sharangdhara 90,91

Kalpana Hina Matra Madhyama Matra Uttama Matra

Kvatha ½ Pala (2 tola) 1 Pala ( 4 tola) 2 Pala (8 tola)

Curna Kalka etc. 1 tola 2 tola 4 tola

Table-3, Matra according Koshta

Authors Mrdu Koshta Madhyama Koshta Krura Koshta

Sushruta92 Mrdu Matra Madhyama Matra Tikshna Matra

Vangasena 1 tola 2 tola 3 tola

iii) According to Vagbhata, persons having less strength, Shodhita previously,

having less quantity of Dosha, having thin structure and unknown Koshta should

be administered Mrdu Aushadha with very less quantity93.

II Pradhana Karma:

Pradhana Karma includes,

Administration of Virechana Yoga

Observation and management during Virechana Vega

Observation of

-Shuddhi Lakshana

-Virechana Vyapat if any

Administration of Virechana yoga:

Caraka has explained method of Virechana elaborately in Charaka94 as, after

completion of Snehana and Svedana, by finding that the individual is cheerful,

slept well, and fully digested his meal, is advised to perform auspicious rites.

Thereafter considering the Vaya, Bala, Dosha, Bheshaja etc, and after passing the

time of Kapha Prakopa in morning the individual should be given Virechana

Yoga in empty stomach.


19

Virechana karma

After administration of the drug, cold water is sprinkled on the face to

avoid vomiting and then the individual is asked to gargle with hot water and to

have fragrance of flower etc. He should be protected from direct cold wind and

should take rest in the bed. He is advised to not to retain the Vega as well as

don’t make Pravahana95.

2. Observation and management during Virechana Vega:

During all the time, Vaidya should concentrate on the manifestation of Lakshana

of Jirna-Ajirna Aushadha, Shuddhi and Vyapat etc.

3. Observation of Shuddhi Lakshana:

Virechana Shuddhi can be assessed as shown in the Table-4, based on parameters

like Vaigiki, Maniki, Antiki and Laingiki Lakshana.

Table-4, Assessment parameters of Virechana

Shuddhi Hina Madhyama Pravara Vaigiki 10 Vega 20 Vega 30 Vega Maniki 2 Prastha 3 Prastha 4 Prastha Antiki Kaphanta Kaphanta Kaphanta Laingiki Lakshana As per described

in Table-5

Manifestation of Samyak yoga, Atiyoga, Ayoga Lakshana and Vyapat should be

observed as per texts 96,97,98,99,100,101

Samyak Yoga Lakshana:

Among different Laingiki Lakshana documented in the classics some are

manifested on the day of Virechana and others on later days. In comparison to

other Shuddhi Lakshana the Laingiki Lakshana is given much importance 102.


20

Virechana karma

Table-5

Samyak Yoga Lakshana of Virechana

Lakshana Caraka Sushruta Vagbhata Srotovishuddhi + - - Indriya Prasada + + - Buddhindriya and Manas Shuddhi + - - Laghuta + + - Agnivriddhi + - - Anamayatva + + Vit-Pitta-Kapha-Vata Kramena Prapti + + - Vatanulomana - + Absence of Ayoga Lakshana - - + Manahprasada - + - Dourbalya + - - Glani + - - Aruci + - - Hrdaya-Varna Vishuddhi + - - Kshudha – Trshna + - - Vegapravartanam in Proper time + - -

Virechana Vyapat:

The complications arising due to improper Virechana Karma are known as

Virechana Vyapat. Ayoga and Atiyoga of Virechana may lead to manifestation of

Vyapat 103,104,105

Opinions of Acharyas regarding Virechana Vyapat are shown in Table-6

Table-6, Virechana Vyapat

Vyapat Caraka Sushruta Vagbhata Adhmana + + + Parikartika + + + Parisrava + + + Hrdgraha + - + Gatragraha + - Sarvangagraha Jivadana + + + Vibhramsha + - Guda Vibhramsha Stambha + - -


21

Virechana karma

Klama + - - Upadrava + - - Vamana - + + Savashesha Aushadhitva - + + Jirna Aushadhitva - + + Hina Aushadhitva - + - Vata Shula - + Vedana Ayoga - + + Atiyoga - + + Hridaya-Upasarana - + - Vibandha - + - Pravahika - + + Visamjnata - - +

III. Paschat Karma:

Following points can be considered under Paschat Karma

Tat Kalina Paschat Karma:

After the stoppage of Virechana Vega, the hands, feet and face of the individual

should be well washed and he should be consoled for sometime and instructed to

follow Pathya as explained in the context of Snehana and Virechana 106.

Kalantarina Paschat Karma:

Individual is instructed to follow appropriate Samsarjana Krama’s as per the

• Shuddhi Lakshana

• Peyadi Samsarjana

• Tarpandi Samsarjana.

Samsarjana Krama is a specific dietary regimen, which is to be followed

after Shodhana Karma. The aim of this Krama is to increase Agni Bala gradually,

which has become weak due to Shodhana. Caraka reveals importance by giving

example that small sources of fire, if simulated by adding small and light fuel,


22

Virechana karma

later on become so big that it can burn anything. Similarly by applying

Samsarjana Krama Jatharagni can be increased to such an extent that it can digest

all types of food 107.

Caraka has mentioned that Peya, Vilepi, Akrita yusha and Krita yusha

should be administered for the period of 3, 2, and 1 meal times to the patient

having Pravara, Madhyama and Avara type of Shuddhi respectively 108.

Sushruta has described Yusha of Kulattha, Adhaki, Mudga and Mamsa

Rasa for this purpose. Dalhana advises that the Peya should be given in the

conditions of Kshina Kapha, but when Vata is dominant Mamsa Rasa should be

recommended 109.

When proper Virechana doesn’t occur at that time instead of Peyadi

Krama, Tarpana is indicated. It is also recommended that the persons addicted to

alcohol, having Vata Pitta Prakrti and if Kapha and Pitta are dominant even after

Virechana Karma, Cakrapani mentioned that in the place of Peya and Vilepi,

Svaccha and Ghana Tarpana should be given respectively 110.

Importance of Virechana

Vamana and Virechana are the main principal remedies in cleaning the

system of all the doshas from the body. On this Dalhana opines, Pakwashayagata

Vata, Pitta and Kapha will be eliminated by 1, 2, 3 Vastis, Dhuma, Nasya, Kavala

etc also eliminate the doshas little by little. Where as Vamana and Virechana will

eliminate the doshas completely out of the body.111, 112

Different varities of virechana

If we gone through our ayurvedic texts mainly we found three types of

Virechana, wheather it may be Anulomana, Srousana, Bhedhana or Rechana,

those three types are


23

Virechana karma

1] Virechana, which is done after Snehana and Swedana followed by Samsarjana

karma.

2] Sadhyovirechana, which is given in the emergency condition, with out Snehana

and Swedana like Vamanavyapata, Kosthabadhata or for the shake of

Koshasuddhi.

3] Nittyavirechana which is giving daily for long time with out considering

Snehana and Swedana followed by Samsarjana karma with consideration of

Kostha and Bala of patient, it may be continued for 8 days or 15 days or 1 month

and so on.

1] Virechana

This type of Virechana has already explained in the previous pages.

2] Sadhyovirechana

Sadhyovirechana contains two words, one is Sadhyo and another is

Virechana, Sadhyo means at that movement or immediate. Virechana means

eliminating doshas from Guda marga by takeing Aoushadha with Mukhamarga.

So totally Sadhyovirechana means instant elimination of doshas with Gudamarga

by taking Aoushadha through Mukhamarga with or without considering Snehana

and Swedana

Scope of Sadhyovirechana

1] Second stage of Vishavega

2] Urdhvaga raktapitta

3] Amavata

4] Vamana Ayoga and Atiyoga

5] Vibhanda

6] Alasaka


24

Virechana karma

7] In weak person if there is a Bahudoshas and if dosha paka have attained

directly Bhedhaniya Aoushadha or Bhedhaniya Ahara dravya can be advised.

Like this still in many conditions we will find in our classics.113

Sadhyovirechana does the effect of eliminating Vishapadhartha and

accumulated fecous thus does Vatanulomana.

Due to administering Sadhyovirechana with or without considering

Snehana and Swedana using of Snehika virechana is beneficial, this holds good

because of in Ruksha person Snigdha virechana have advised.114, 115 Other wise

giving Ruksha virechana to a person who has not under gone for Snehapana will

destroy like dry stick when bends it.

We get strong reference of using Sahdyovirechana with Eranda tail

combining with Triphala kwatha in Chakradatta116 Yogaratnakara117 and

Sharangdhara118 uttara khanda.

Even for the test of Krura kostha, Madhyama kostha and Sadharana kostha

this type of Sahdyovirechana helps.

In Kruradikostha giving Eranda tail as a Sahdyovirechana is the choice of

drug. Even instead of Eranda tail Ksheera can also be used in that condition.119

3] Nittyavirechana

The literary meaning of Nittyavirechana includes two words, one is Nittya

and another is Virechana. Nittya means everyday or consecutive days for two or

more than two days, Virechana means eliminating doshas from Guda marga by

takeing Aoushadha with Mukhamarga. So Nittyavirechana gives the meaning as

administering virechana Aoushadha everyday or consecutive days for two or more

than two days.


25

Virechana karma

Paryayanama of Nittyavirechana

1] Nittya shodhana

2] Nittya anulomana

3] Nittyavirechana

Scope of Nittyavirechana

A debilitated person who has under gone Shodhana therapy earlier and a

person who has very little quantity of doshas inside the body but he is emaciated

and he whose nature of Kostha is not known should be given mild drugs in small

doses, better still in repeated doses, other wise it will create doubt of fatal

condition.

If in a debilitated person the doshas are found to be in motion [Chalan

doshana] and in large quantity they should be removed out of the body little by

little using mild drugs and if they are in little quantity they should be mitigated by

Shamana therapy. Other wise if they remain in side the body for long time causes

trouble to the body and might even kill the person if they are not expelled out of

the body. 120,121,122

Dalhana opines Chalana doshan as Kupitan doshan, Indu commentator of

Asthangha sangraha opines on Chalana doshan, as doshas are in Prabhuta matra

doshas should be eliminated with Mrudu Virechana dravya. Arunadatta comments

on above version, as taking Virechana Aoushadha everyday day is Shrestha or

Varam.

Before giving Shodhana Karma we should win over Kapha and Vata in the

Mandagni and Krurakostha than only Virechana aoushadha can be given.123, 124,125

Even Bhoja also opinions that if doshas are less aggravated they should be

mitigated by Shamana chikitsa, if the Bahudosha condition is their, they should be

eliminated little by little with out harming the patient.


26

Virechana karma

Doshas, which are mitigated by Shamana chikitsa, are likely to reappear

again but those, which are expelled out of the body by Shodhana Karma i.e. by

Vamana and Virechana, do not re-occur. This statement does not holds good in

some conditions like Udararoga, Amavata, etc because in these diseases everyday

the re-accumulation of doshas will takes place that’s why in these type of

condition Nittyavirechana helps in eliminating the doshas which accumulate

daily.

In above told condition Mrudu type of Nittyavirechana helps. Mrudu

means we can use Draksha, Paya, Ushnambu or Tail, Commenting on Tail

Adamalla opines to consider Eranda tail.

While explaining Abhayadimodaka it is well explained that when taking

Nittyavirechana in little quantity there is no any restriction of food or other

activities or in this condition Tarpanadi karma can be followed other wise

Shastika shali anna with Yavagu of Mudga and other grams or Jangala mamsarasa

with Shastika shali anna is benifisial.126

Benefits if Nittyavirechana

1] Helps to eliminate doshas which accumulate everyday.

2] Act as Rasayana if they are taken for long time. For example Eranda tail and

Abhayadimodaka.


27

Basti karma

Vasti karma

Vyutpatti

“Vasti” the word derived from the root “Vas” with the suffix of Prattyaya

“Tich”.

Nirukti and Paribhasha

1. Using Ajadi Vasti Putaka for the use of giveing Aoushadha is called

Vasti.127

2. Due to giving medicine by Vasti Putaka is called Vasti.128, 129,130

3. Due to administering medicine in to Gudamarga with Vasti is called

Vasti.131

4. Which is Sadhyakarma with Mootradhara Putaka is Vasti.132

5. The karma while moveing in Nabhi, Kati, Parshwa, Shroni churns up the

stool including all the other doshas located their, and appropriately

eliminates them with easy after doing Snehana of body is called Vasti.133

Vasti Karmukhata

Vasti is one of the best Chikitsa in Panchakarma, its action will not be

restricted to only Pakwashaya Shodhana where as it acts all over the body. By

mixing different drugs it acts as Shodhana, Shamana, Lekhana, Brouhana,

Vajikarana, Vayasthapana etc.134 So Vasti can be used in any type. Now its mode

of action will be explained as follows.

Just as the cloth absorbs only colour from the solution of Kusumbha and

other coloring substances, so also the Vasti expels out from the body only the

doshas, which have been maid moist.135, 136

The body is sustained by Vayu because of its ability to cause detachment

of any adhesion. Vayu alone or along with other doshas get aggravated in its own

habitat. Vasti by its Shodhana action causes downward movement of that Vayu

A Comparative Study of Virechana karma and Basti karma in Amavata 28W.S.R.T. Rheumatoid Arthritis

Basti karma

along with Pitta, Kapha and feces. Because of allivetion of this Vayu, all the

diseases pervading the whole body get alleviated.137

Chakrapani comments over above point and says, science Vasti causes

alleviation of basic Vayu located in Pakwashaya other connected Vayus else

where in the body gets automatically alleviated. This holds good similar

destruction of a tree by cutting its root. This explains the cure of all the diseases

of the body by simply correcting the Vayu located in its basic habitat ie colon.

In Charaka siddhi Vasti is described to draw out all doshas from the foot

to the head by its Virya.

Medicine injected through rectum remains in the intestines in the region of

the pelvis and below the umbilical region. The potency Vasti dravya spreasds all

over the organism from the Pakwashaya just as the potency of the water poured at

the root of the tree tends to permeate the whole tree through its minutest cells and

fibers. The liquid part of Vasti is emitted out through the rectum either by it self

or with feocal matter etc. But its potency acts over whole organism through the

intervention of Apana and other Vayus. The potency of the Vasti dravya in the

Pakwashaya acts on the while organisam from top to toe, like the sun in the haven

acting on the humidity of the earth below. Vasti if applied correctly tends to

eliminate completely from the system all the doshas accumulated in the region of

the back, waist and abdomen.138, 139,140

Importance of Basti karma

Vata is the Neta141 of all Dosas, it is considered as Ishvara142 and it is the

causative factor for all trimargaja rogas 143,144. For this type of Vata Vasti is the

best amoung other Karmas.This Vasti is considered as Ardha chikitsa because of

disease produced by Vata are 80 in number.145


Basti karma

Vasti can be utilized in Bala, Vridha, Krasha, Sthoola, Kshina dhatu

person, and in Sthree.146 In the Snehadi karma Basti is chief, because of having

Shodhana effect, Shamana effect, Sangrahana effect, Vajikarana effect, Brohana

effect etc.147

Vasti is beneficial if it is used with different drugs in Vata, Pitta, Kapha,

Samsargaja and Sannipataja disorders.148, 149

Vasti is Amruta samana in Shishu and Ashishu, 150 when Vasti is used in

combination of Niruha and Anuvasana it eradicates all type of diseases.151

Main specialty of Vasti is first it do the Utkleshana of doshas than

Shodhana of doshas and lastly Shamana of doshas.152, 153,154

It is the only one Karma which we found to be given continuously for 324

days, if Vasti is taken for such days person neither become old nor sick, lives for

thousand years with keen sense organs, devoid of sins shining like gods, like a

stallion in matters of sex, like a elephant in strength with steady mind, sense

organs and digestive activity.155

Vasti if appropriately administered keeping in view the strength of patient

doshas involved in the causation of disease, nature of disease of disease, physical

constitution of patient and properties of different groups of drugs prescribed for

different diseases cures these ailments.156

No other therapeutic measures other than Vasti cleanses the body quickly

and easily, causes depletion and nourishment instantaneously and is free from any

adverse effect.157

Vasti is useful in Pangu, Urustambhs, Bhagna etc.158

Virechana and Vamana therapy no doubt causes elimination of doshas but

it involves intake of recipe ingredients of which are pungent, sharp, hot etc.Those


Basti karma

ingredients causes’ unpleasantness eruption nausea cardiac discomfort and pain in

the gastrointestinal tract.159

Infants have immature tissue and less of strength, there is diminution and

reduction in strength in old people. For both these category Virechana and

Vamana therapy is contraindicated. Asthapana type of Vasti can however be

given for elimination of doshas and nourishment of body. Vasti therapy

instantaneously promotes strength, complexion, sense of exhilaration and

tenderness as well as unctuousness of body.160

Basti Effect:

(1) Promotive aspects

• Sustains Age.

• Provides better life, improves strength, digestive power, voice and

complexion.

• Perform all functions

• Provide firmness

• Corpulence quality.

• Lightness in viscera / systems because removes morbid matter from

all over the body.

• Restores normalcy.

• Increases Relish

(2) Curative aspect

• Relieves Stiffness

• Relieves contractions and adhesions.

• Effective in paralytic conditions

• Effective in dislocation and fracture conditions


Basti karma

• Effective in Those conditions where vata aggravated in Shakha /

extremities.

• Relieves pain

• Effective in disorders of GI tract

• Effective in diseases of Shakha and Kostha.

• Effective in diseases of vital parts, upper extremities localized or general

parts.

• Beneficial to debilated and weak persons.

• Arrest premature old age and the progress of white hair.

(3) Preventive aspects

• Beneficial in constipation.

• Effective to purify various systems of the body.

(4) Effect on dhatu :

• Increases the quantity and quality of sperm

• Effective to restore the normal functions of blood and other dhatus.

• It provides strength by increasing muscle power.

• Beneficial as geriatrics

5) Effect on Brain and Psychology

• Improves intellectual power

• Provides clarity of mind

• Improves clarity of sense organs

• Induces sound sleep

• Lightness

• Exhilaration

• Invigorates eyesight


Basti karma

• Spright lightness of mind

(6) Effective at any age and in any season

• Basti is non antagonistic to healthy, diseased and old persons

• Applicable in all seasons

• Basti can be administered in child and older person too, because it is free

from complications.

Types of Basti

Two types of basti

• Niruha basti, Auvasana basti 161

• Niruha basti, Snehika basti 162

• Shita basti, Sukhoshna basti 163

Three types of basti

• Asthapana basti, Auvasana basti, Uttara basti.165, 166,167

• Utkleshana basti, Shodhana basti, Shamana basti 168,169,170,171

• Karma basti, Kala basti, Yoga vasti.172, 173,174

• Vatahara basti, Pittahara basti, Kaphahara basti.175

• Sneha basti, Anuvasana basti, Matra basti.176

• Teekshna basti, Mrudu basti, Sadharana basti.177

• Kaphavatahara basti, Kaphapittahara basti, Pittaraktahara basti.178

Four types of basti

• Asthapana basti, Auvasana basti, Uttara basti Matra basti.179

• Pakvashayagata basti, Shiro basti, Kati basti, Vrana basti.

Five types of Madhutailika basti

1] Madhutailika basti180

2] Youktaratha basti181


Basti karma

3] Doshahara basti182

4] Siddha basti183

5] Mustadiyapana basti.184

Six types of Vasti [On the Basis of Rasa predominance in the Basti Dravya]

(1) Madhura Rasa Skandha Dravya Basti

(2) Amla Rasa Skandha Dravya Basti

(3) Lavana Rasa Skandha Dravya Basti

(4) Katu Rasa Skandha Dravya Basti

(5) Tikta Rasa Skandha Dravya Basti

(6) Kasaya Rasa Skandha Dravya Basti

Eight types of basti 185

1. Chatuprasruyika basti

2. Panchaprasruyika basti

3. Shatprasruyika basti

4. Saptaprasruyika basti

5. Astaprasruyika basti

6. Navaprasruyika basti

7. Ekadasa Prasrta Basti

8. Dwadashaprasruyika basti.

Ten types of Vasti [On the Basis of chief drug]

(1) Ksira Basti

(2) Mamsa Rasa Basti

(3) Gomutra Basti

(4) Rakta Basti

(5) Kshara Basti

(6) Dadhimastu Basti


Basti karma

(7) Amlakamji Basti

(8) Prasanna Krta Basti

(9) Sura Krta Basti

(10) Asava Krta Basti

Fifteen types of basti

1] Vatahara basti

2] Pittahara basti

3] Kaphahara basti

4] Raktahara basti

5] Kaphavatahara basti

6] Kaphapittahara basti

7] Pittaraktahara basti

8] Pittavatahara basti

9] Pittaraktahara basti

10] Raktakaphahara basti

11] Raktavatahara basti

12] Vatapittakaphahara basti

13] Vatapittaraktahara basti

14] Kaphapittaraktahara basti

15] Vatapittakapharaktahara basti

Brief introduction about some important Vasti

a. Niruha Basti (Evacuative or Un-unctuous Enema):

In Niruha Basti, Kashaya (decoction) is the predominant content. With

the Kashaya, Madhu, Saindhava, Sneha and Kalka are the ingredients

commonly used. Its synonyms are Asthapana Basti, Kashaya Basti etc.


Basti karma

The Basti, which eliminates the vitiated Dosha from the body and

increase the strength of the body because of its potency, is called Niruha

Basti.

Because of this enema stabilizes the age (Vaya), stabilizes the normal

functions of Dosha and Dhatu and stabilizes Deha i.e. strength of the body, is

called Asthapana Basti 187.

Depending upon drugs and preparations used in Basti it may be

classified as follows: 188

Madhutailaika Basti

Yuktaratha Basti

Yapana Basti

Siddha Basti

b. Anuvasana Basti (Unctuous Enema):

In this type of Basti only Sneha is used. According to the quantity of

oil given, it is subdivide as follows:

The Sneha Basti which will not cause any harm even if it is retained

for one day and can be administered after taking food, therefore it is called

Anuvasana Basti

Sneha Basti 1/4th to the quantity of Niruha i.e. 6 Pala (298ml). Anuvasana Basti The quantity of Sneha is half of the Sneha Basti i.e.

3 Pala (144ml). Matra Basti This is the minimum quantity of Sneha Basti (½ of

Anuvasana Basti) i.e. 1½ Pala (72ml). 189,190


Basti karma

B) Anatomical Classification:

It depends upon the part of the body used for the administration of Basti.

Internal application:

• Pakvashayagata Basti

• Uttara Basti

a. Garbhashayagata Basti

b. Mutrashayagata Basti

External application:

Vranagata Basti Kati Basti

Shiro Basti Netra Basti

C) According to the number of Basti to be used:

Karma Basti - 30 Basti - 12 Niruha & 18 Anuvasna Basti

Kala Basti - 16 Basti - 6 Niruha & 10 Anuvasana Basti

Yoga Basti - 8 Basti - 3 Niruha & 5 Anuvasana Basti

In the above types fixed sequence of Niruha and Anuvasana Basti is

followed.

Rectal Administration:

Substances may be introduced into the rectum for exciting evacuation or

for medication, which later may be intended for effect in three different locations.

• For effects on the contents of the colon for which the term "endocolonic

might be suggested to differentiate it from,

• Effect to be exerted on the tissue of the colon, for which the term

encolonic might be a suitable designation and

• For administration by the way rectal medication intended for systemic

action for which the term diacolonic might be employed.

• Before one resorts to rectal administration it is a good rule to make a

digital examination of the rectum.


Basti karma

• Rectum distended with fecal matter should be cleaned out by an evacuate

enema before it is given the task of receiving medication.

• Rectal injections, also known as enemas, clysters or Lavements may be

large or small.

Why rectal administration?

1. When it is desired to spare the stomach and intestine from the action of the

drug or to protect the drug from the action of the digestive ferments.

2. With children, who will not take disagreeable tasting medicaments, or with the

insane, who refuse to swallow, rectal administration may become an

important recourse.

3. Such a bitter substance as strychnine can best be given to children in

suppository form provided this method of administration is carried out

gently, skillfully and tactfully.

Enemas:

Rectal injections, also known as enemas, clysters or lavements, maybe

"large" or "small". An enema of less than half a liter might be considered a small

enema and of more than half a liter is a large enema.

1. When a rectal enema is given by means of a syringe with a short tip, it is

deposited just within the sphincter of the anus, a portion of the rectum that

is normally very intolerant of sudden distention. It is indeed this

irritability, which is responsible for the prompt evacuation of any fecal

matter that arrives in this part of the bowel. For this reason, even a small

quantity of fluid, when given rapidly, tends to cause evacuation.

2. When, on the other hand, the enema is administered very slowly, it

suppresses evacuation reflex and reaches to the upper part of the colon

which is not only more retentive but also more absorptive than the rectum.


Basti karma

3. After the drug once passes the anal sphincter, will pass easily up to the

sigmoid and descending colon, across and down to the caecum regardless

of the position of the body of the patient.

a. Cool large enemas are believed to excite the gallbladder for

contraction and are advocated in the treatment of catarrhal

jaundice. Irritation of the colon is a long established form of

treatment for the various types of jaundice. Garbat and Jacobi offer

an experimental demonstration of the possible efficacy of this

treatment. They found that within a period of from three or twelve

minutes after the instillation of various solutions high into the

rectum a flow of bile was obtained from the duodenal tube, that

would continue for from eighteen to sixty minutes without any

interruption.

b. Hence, the introduction of various solutions into the upper part of

the rectum produces drainage into the duodenum of bile that comes

directly from the liver and without contraction of the gallbladder.

(A) Evacuate enemas:

1. Evacuate enemas in increasing order to potency, should be repeated every

three or four hours, care being taken not to over distend the colon, until

success is secured or the uselessness of the procedure becomes evident.

2. Whether large or small, hot or cold, simple or medicated enemas should be

employed to secure evacuation in any one case depends on the conditions

present.

3. If the rectum merely is to be emptied of feces, 0.5-liter enema given

rapidly with the patient in the sitting posture suffices. If, on the other hand

the most thorough possible cleansing of the bowel is aimed at (colonic


Basti karma

flushing), the largest possible quantity of warm water from 1 to 2 liters is

slowly introduced with the patient recumbent in the lateral or Sims

position ; or, better still in the knee-chest position.

4. On the other hand, a small (0.25 liter), cool enema rather quickly injected

into the bowel, to stimulate it to evacuation, maybe considered one of the

least objectionable procedures, even when employed quite habitually.

(B) Oil enemas:

Though oil enemas are essentially evacuant enemas, they are given with

the technique of the retention enema, because they are to be retained for many

hours, usually over night.

Indications:

1. To soften feces, in constipation characterized by the formation of hard

scybala and in that due to partial obstruction of the colon.

2. For evacuate action, in so-called spastic constipation, in pelvirectal

constipation and in any other form of constipation and in which oral

administration of cathartics is contraindicated by gastric disturbance.

3. For soothing action, in excessive irritability of the colon and rectum, in

colitis and in proctitis.

4. It has been suggested that oil enemas might inhibit absorption of toxic

products. That the oil has the power of removing substances soluble in it is

shown by the fact that it is passed dark yellow or olive green and of

offensive odour.

There is no definite knowledge, however, of the degree to which this

property might be of clinical value.


Basti karma

Rules:

1. The oil must be pure and free from rancidity. This is more important than

that it come from a certain source. (Thus poppy seed oil, oil of sesame or

cottonseed oil, when pure, is just as good for this purpose as olive oil).

2. The oil should be placed in a basin of hot water until it has acquired blood

heat (100 F).

3. The oil enema is given at bedtime, unless it produces discomfort and

interferes with sleep. In such case it may be taken early in the morning,

and the patient may lie in bed for three or four hours after ward.

4. The patient should understand that, unless the oil remains in the intestine

for several hours at lest satisfactory results cannot be expected. The total

quantity to be injected depends, therefore, on the patient's ability to retain

it.

5. This is so variable that no definite quantity can be stated. The principle to

be followed is to have the patient gradually increase the amount injected at

successive times until a satisfactory amount can be introduced and

retained.

(C) Retention enemas:

Technique:

It is well to precede a retention enema by a cleansing enema, so as to

unload the lower part of the bowel of fecal matter that may be contained in it,

thereby lessening distention and favoring retention.

1. The smaller in bulk the enema the better it is retained.

2. Still, to be retained, it must also be quite devoid of irritating properties.


Basti karma

3. The retention of an irritative substance may be favored by making its

solution as nearly isotonic as possible, and by using colloidal fluid, such as

starch water as diluents.

4. If the fluid is introduced very slowly and steadily, the rectum does not

become as readily aware of the distention and retains a quantity of fluid

that would otherwise be expelled.

5. Giving the enema at body temperature favors retention, as extremes of

temperature excite peristalsis.

6. The patient should assume the recumbent position for at least an hour after

the injection, and should be instructed to resist any inclination to

evacuation as much as possible.

(D) "Nutrient" enemas:

Why? The attempt has been made to maintain nutrition by rectal feeding

when it is impossible or undesirable to introduce food into the stomach, or when it

cannot be retained. But the colon has hardly any digestive power and it absorptive

capacity even for water-soluble substances of large molecular size is very poor

and nil for fat.

Rules:

1. Not more than three nutrient enemas should be given in the twenty - four

hours, at about eight hour intervals. The amount should at first not exceed

150 cc., to be gradually increased to 300 when given as ordinary enemas,

though when given by proctoclysis the quantity may reach 1 liter.

2. After each administration the patient should keep as quite as possible for

at least two hours and suppress any desire to evacuate the bowel.


Basti karma

3. In point of fact patients who need nutrient enemas should be kept in bed

continuously; at rest in bed lessen the consumption of calories by at least

25 per cent.

4. A daily cleansing enema is advisable. This should precede the nutrient

enema by about an hour.

(E) Medicated enemas:

Medicated enemas are given by the technique of retention enemas. They

may be employed, as previously stated, for endocolonic, encolonic or diacolonic

action.

Oil may be used as a vehicle for diacolonic administration of oil-soluble

volatile bodies. On the basis of extensive experience by Gwathmey.

Thus from above description we can easily understand the role of madhu,

saindhav and sneha in each basti. Above description resembles to the ayurvedic

description of basti karma up to maximum extent. Though modern science

developed other advanced routes for the drug administration so now days they are

not using this route but they cant deny the importance of this route


Amavata

Disease Review

Amaravata describes a wide range of joint disease manifestations.

Amavata is mainly caused by two factors ama and vata.

Etymology of Amavata

1. ‘Amena samhita vata Amavata’. The virulent Ama circulates in the whole

body propelled by the vitiated vata dasa producing block in the body

channels that stations itself in the sandhi giving rise to Amavata191.

2. The combinations of ‘Ama’ and vata form Amavata. It shows the

Pridomminance of Ama & vata in the samprapti of Amavata 192.

3. Ajeerna produce ‘Ama’ & along with vata it produce Amavata193.

Definition

‘Ama’ is produced by agnimandya of both Jatharagni and Dhatwagnis.

Even though ama is a cause for various diseases, in Amavata it is the main

causative factor. Ama and vata vitiated simultaneously and disease is manifested

mainly in joints of hasta, pada, sira, trika, gulpha, janu and uru. The main

symptioms produced are Angamarda Aruchi, Trishna, Alasya, Gouravam, Apaka

& Shotha 194.

Importance of Ama in Amavata

The main causative factor for the manifestation of Amavata is Ama. So it

is necessary to know about the Ama in detail.

Etymology of Ama

1. The unprocessed or undigested food partical is Ama 195.

2. Ama means, “Which is subject of digestion”. 196


44

Amavata

Definition of Ama

1. The first Rasa dhatu, which has been inadequately digested due to the

weakness of digestive fire and accumulating in the stomach in the

abnormal state, is know as Ama 197,198.

2. The undigested Adya Ahara dhatu is Ama 199.

3. The food material which will not undergone vipaka, leads to Durgandha,

which is large in quantity, which is picchila & which leads to Gatra

Sadana is called Ama.

4. Due to impairment of digestive fire the undigested remained food material

is ‘Ama’.

5. Apakva Anna Rasa is Ama & some other considers the accumulation of

mala as Ama & still other opines the first stage of vitiation of dosa as

Ama.

On the basis of the for going, Ama may be classifieds as below

I) Ama produced due to hypo functioning of Agni i.e

1) Ama due to Jatharagni Mandya.

2) Ama due to Dhatvagni Mandya.

3) Ama due to Bhutvagni Mandya.

II) Ama produced irrespective of the action of Agni

1) Accumulation of mala.

2) Ama due to interaction & virulently vitiated dosas

3) First phase of dosic vitiation.

Vata in Amavata

Voluntary & involuntary functions are all under the control of Vaya. In

Amavata the normal function of Vata is disturbed. It produces stabdhata &

sandhigraha leading to the restricted movements of joints & it will become the


45

Amavata

responsible for crippling effect seen in the patients. This shows that predominance

of vata dosa in the pathogenisis of Amavata.

Now let us carry a brief description of vata dosa. The word vata derived

from “Va gati gandhanyoh” it means to move, to make known, to enthuse 200. It

has got the other synonyms like Anila, Maruta, Pavana etc.201

Gunas of Vata

Ruksha, Seeta, Laghu, Sukshma, Chala, Visada, Parusha & Khara 202,203.

Functions of Normal Vata

Vaya sustains the body with expiration, inspiration, enthusiasm, movement of

various parts. Kneenees (sharpness) of sense perception, initiation of the natural

urges and many other functions204.

1. Tantrayanradhara

2. Cheshta Pravartaka

3. Mano Niyanta & Praneta

4. Sharvendriya Uttyojaka

5. Sharvendriya Artha Abhivodha

6. Sharva sharira dhatu Vyuhakara

7. Sharira Sandhanakar

8. Vak pravartaka

9. Sabdasparsa Prakrti

10. Srota sparsana mula

11. Harsha utsahayoni

12. Agni samirana

13. Mala ksepta

14. Grabhakrti Karta

15. Ayusha Anuvratti 205.


46

Amavata

Importance of Vata

Pitta, Kapha, Dhatu & Mala are movementless, unless they are brought to

the proper place by vata to carry out their functions. Thus Vayu makes the

functions of all the tissues of body 206.

Symptoms produced due to Ama

1. Srotordha

2. Balabramasa

3. Gaurava

4. Anila Mudhata

5. Alasya

6. Apaki

7. Nisthivana

8. Mala sanga

9. Aruchi

10. Klama

11. Vit, Mutra, Nakha, Dhatu, Chakshu Pitata/Raktata/Krishnata

12. Prusthtasthi, Katisandhi Ruk

13. Siroruk

14. Nidra

15. Mukhavairasya

16. Jvara

17. Atisara

18. Romaharsa.

Symptoms of Vataprakopa 207

1. Parava Samkocha

2. Stambha


47

Amavata

3. Asthi Paravabheda

4. Lomaharsa, Pralapa, Hasta-Pristha-siro-graha

5. Khanjata-Pangulya

6. Kubjata

7. Sosha

8. Anidra

9. Grabha-sukra-Rajonasa

10. Spandana

11. Gatra Suptata

12. Sira, Nasa, Akshi, Jatru, Grivahanunam-Bheda ,Toda-Arti

13. Akshepa

14. Moha

15. Ayasa

Nidana of Amavata

Nidana is defined as the factors which deranges the dynamic state of

doshic equilibrium provokes the disease is known as Nindan. This Nidana

helps us to decide the line of treatment as well as prognosis of the disease.

Amavata Ninda is of multifaceted various Acharya’s mentioned their

different views for the productions of Ama in Amavata.

Madhavakar 208 has delt the separate Nidana as

1. Viruddha Ahara (Incompatible food)

2. Viruddha Chestha (Incompatible food)

3. Mandagni (Hypofunctiony of agni)

4. Nischala (Lack of exercise)

5. Snigdha Ahara followed by immediate exercise.


48

Amavata

Besides these intakes of Kanda, mula and sakha and excessive exertion are

itiological factors opeined by Harita 209.

In Anjana Nidana which vititate vata, pitta and kapha are considered under

Nidana 210.

These all above Nindan can be included under two heading

1. Unwholesome diet & 2.Erroneous habits.

Unwholesome diet means “which aggravates the body humors but not

expel them out of the body” 211. Charaka has mentioned 18 types of

unwholesome diet (Viruddha Ahara) 212 some of the virudha Ahara are as

follows

1. Milk along kulatha,

2. Panase fruit with matsya

3. Mixtures of equal quantities of honey & ghee.

4. Boiled curd 213.

Erroneous habits (Viruddha chesta) mainly included alternate use of cold

and heat, suppression of natural urges, sleeping daytime, walking at night, over

indulgence in work.

Table No-7, Amavata Nidana according to various Acharyas.

Sr Nidana H.S. M.N. A.N. i. Viruddha ahara - + -

ii. Guru ahara + - - iii. Tarpite kandashakastu + - - iv. Mandagni + + - v. Viruddha cheshta - + -

vi. Avyayama + - vii. Snigdha bhuktavato hiannam vyayama - + -

viii. Swa prakopnaiha : Vatadosha Pittadosha Kaphadosha

- - +

ix. Vyavayina + - -


49

Amavata

Samprapti of Amavata 214

The impairment of Agni will produce the condition of Ama. Mainly

Agnimandya initially affects digestion followed by metabolism. Hence in this

state of Agni, the Rasadhatu is not formed up to the standard level & it is

considered as Ama. This ‘Ama’ along with Vyana Vayu and also by virtue of its

Vishakari guna it quickly moves to all kapha sthanas, through Hridaya and

Dhamanes. This Vidhagada Ama, in kapha sthana is further contaminated by

dosas and assumes different colours, because of the Atipichhilata.

If Ama gets obstructed in to channels and promotes further vitiation of

vata dosha, this morbid Ama circulates ubiquitously in the body propelled by

vitiated vata with predilection for shesma sthana. On the dhamanies with the other

dosas it facilitates sroto abhisyanda and srotorodha causing sthanasmsraya

manifested stabdhata (stiffness), sandhisula (joint-pain), sandhishotha (swelling),

Anga marda(body ache) Apaka(indigestion), Jwara (fever), Anga gourava

(heaviness of body), Alasya(laoghess) etc symptoms of Amavata.

According to the commentators on Madhava Nidana the Samprapti of

Amavata can be summarized accourding to Shatkriyakal

Sanchaya & Prakopa: When a person is exposed to aetiological factors like

Viruddha Ahara, does vyayama after intake of snigdha ahara, Chinta, Krodha etc.,

Agnimandya is there leading to Tridoshadushti and Amotpatti in the Sanchaya

and Prakopavastha.

Prasara: With the help of Vata (Biophysical mechanism), this Ama gets Prasara

to shleshma sthana producing mild sandhishoola etc. along with Ama symptoms.

Then Ama gets interacted with Tridosha and further modified (Vidagdha) to great

extent and yagapatakupitavanta of Ama and Vata takes place via Rasavaha srotasa

(Dhamani).


50

Amavata

Sthana Sanshraya: This prasarita Ama, which viscid, unctuous and guru endures

Sthana Sanshraya in Hridaya, Trika Sandhi and Sarvanga (Srotoabhishyanda)

leading to Dosha-dushya Sammurchchana. Primarily the disease is not manifested

completely, so only initial mild symptoms like Aruchi, Apaka etc. are observed

which can be considered as purva rupa of the disease Amavata.

Vyakti: As it reaches vyakti stage most of the symptoms of Amavata are

manifested like Vrishchika dashavata vedana, stabdhata etc. In Adibala Pravrita

cases (Karmajanya, Mata-pita apcharajanya etc.) Khavaigunya is already there

and with the minor nidana sevana disease in manifested.

Bheda: In chronic stage or if the disease is left untreated it reaches bhedavastha-

producing updrava like Sankocha, Khanjata etc.

The Samprapti Ghatakas, which are involved on the Amavata, are as follows.

1. Dosha-Tridosha mainly vata(vyana, samana, Apana) and kapha ( Kledaka,

Bodhaka, slemaka)

2. Dhatu -Rasa, Mamasa. Asthi, Majja.

3. Upadhatu -Snayu and Kandara.

4. Srotases -Annavaha, Rasavaha, Asthivaha, Majjavaha.

5. Srotodusti -Sanga, Vimaragagmana.

6. Udbharasthana- Amashya (Ama), Pakvasaya (vata).

7. Adhisthana -whole body

8. Vyaktasthana -Sandhi

9. Avayava -Sandhi.

10. Vyadhiswabhava -Mainly Ashukar.

11. Sanchara Sthana -Hridya, Dhamani.

12. Roga Marga -Madhyama roga marga

13. Agni -Jataragni Mandya, Dhatwagni Mandya.


51

Amavata

FLOW CHART-1

SAMPRAPTI

Virudha Ahara + Virudha Vihara

Agnidusti in Amashaya

Formation of Amarasa

Sanchara through Dhamani all over

The body by vata dosha

Samadosha Accumulates in the

Slesma sthanas like

Amashaya, Sandhi etc

Enters Into Kosta, Trika Sandi

Leads to

Gatra Stabdata

Karoti Sarujam shotam

Yatra doshaha prapadyate

Leads to painful swelling of joints wherever the vikrita dosas travels.

Angamarda, Aruchi, Apaka,

Gourava, Jwara, Sandi Ruja

Sandi shota

Amavata.


52

Amavata

Purva roopa of Amavata

In the classics it is not clearly mentioned purva roopa of Amavata. But

however in such condition Avyakta lakshana prior to the manifestation of

disease is considered as the purva poorpa 215. With the help of this the purva

roopa of Amavata can be considered as follows

1. Dourbalyam (Weakness)

2. Haridaya gourava (heaviness in chest)

3. Gatra stabdam (Stiffness of the body)

4. Apaka (indigestion)

5. Anga mardu (Aching all over body)

6. Gourava (Heaviness)

7. Aruchi (loss of taste)

8. Alasya (lack of enthusiasm)

9. Jwara (fever)

10. Sandhi vedana (Joint pain)

Roopa of Amavata

“Utpanna Vyadhi bhodakameva lingam rupam” 216.

It means which gives the idea about the manifested disease is known as

‘Rupa’.

Madhavakara 217 while describing Amavata lakshana, he has considered

them in to two heading one is samanya lakshana another is lakshana

samachaya of pravrudhu Amavata.

Samanya Laxanas are as follows

1. Angamarda (body ache)

2. Aruchi (Tastelessness)

3. Trishna (Thirst)


53

Amavata

4. Alasya (lack of enthusiasm)

5. Gouravam (Heaviness all over body)

6. Jwara (Fever)

7. Apaka (Indigestion)

8. Shunata Anganam (Swelling all over the body mainly in joints)

Pravriddha Lakshana of Amavata:

It is the advanced stage of disease and very troublesome to patients as

well as for physicians. According to Kriyakala and stage wise development, it is

the worst stage of disease. Articular and Extra-articular feature present in this

stage have been elucidated by Acharya Madhavakara, Bhava Mishra and Yoga

Ratnakara.

According to Madhavakara 218

1. Sarujam Sandhishotha – Hasta, Pada, Shiro, Gulpha, Janu, Uru Sandhis are

chiefly involved in Amavata.

2. Vrishchika danshavata vedana – This kind of pain shows the presence of

Ama at the site of pain.

3. Utsahahani – A subjective feeling in which lack of enthusiasm can be seen

in suffering person. It is due to insufficient nutrition of Sharira Dhatus,

Indriya and Mana.

4. Bahumutrata – Presence of vitiated or dushita Ama causes sroto –

abhishyanda in the body, which leads to increase of kleda. This Bahumutrata

occurs for the excretion of excess kleda from the body.

5. Kukshikathinya – Vitiated Samana and Apana Vata along with the Ama

leads to Kukshikathinya, which is the rigidity of abdomen.


54

Amavata

6. Kukshishoola – Srotorodha due to Ama causes obstruction to normal

movement of vitiated samana and apana Vata resulting in pain in abdomen.

7. Nidra Viparyaya – Due to vata vriddhi, pain gets aggravated at night and

keeps the patients awaken which leads to Nidra Viparyaya.

8. Chhardi 219

Continuous formation of dosha leading to excitation of Amashaya by

Vata causes Chhardi.

9. Bhrama - Presence of Kapha in Srotas and Vitiated Vata causes Bhrama.

10. Murchcha - Inability of the sensory organs to perceive the sense objects is

Murchcha. Loss of motor function occurs in Murchcha due to upatapa of

Indriya by Vitiated Vatadi doshas 220

11. Hritgraha - It is due to Rasavaha srotodushti (its mulasthana is Hridaya) and

vitiation of Samana Vata, Vyana Vata and Avlambaka kapha. Hritgaurava is

also produced due to above reason when vitiation is mild.

In R.A. cardiac manifestations like Pericarditis, Myocarditis,

Conduction defects etc. can occur.

12. Vibandha – It is due to vitiated Apana Vata and improper degradation of

Ahara into Sara and Kitta.

13. Antrakujana – In this feature, increased bowel sounds are present due to

movement of Vitiated Vata in the intestine.

14. Anaha – It is the stagnation of vitiated vata in Kukshi.

15. Agnimandya – Vicious cycle of disease (Agnimandya-Shuktatva –

Annavisha) produces Agnimandya again and again.


55

Amavata

16. Praseka – It means lalasrava 221. Excessive thick, mucoid, salivary secretions

are produced due to Samarasa, which shows Rasavaha and Udakavaha

srotodushti.

17. Gaurava – Due to Vitiated Kapha there is feeling of heaviness in Hridaya

and body parts preferably in Joints.

18. Vairasya 222

Perception of different taste than normal due to Sama Rasa and

vitiated Bodhaka Kapha.

19. Daha - Due to Vitiation of Pitta sometimes localized or generalized Daha

occurs.

Warmth of the joint is usually evident on examination. In its most aggressive

form, rheumatoid vasculitis can cause Mononeuritis multiplex (Harrison 1994).

20. Trishna – Trishna is due to Agnidushti, Sama Pitta and Vata. It shows

Rasavaha, Udakavaha srotodushti in disease process.

Table No.8 Similarity between Amavata and Rheumatoid Arthritis

Rheumatoid Arthritis Amavata

Morning stiffness Gatra sthabdata or sandhi sthabdata

Arthritis of 3 or more joints Bahu sandhi shotha

Arthritis of hand joints Hasta, sandhi shotha

Symmetrical arthritis Bahu sandhi shotha (ubhaya)

Rheumatoid nodule Angavaikalya

Rheumatoid factor ----

Radiological changes ----

The first 4 criteria of RA can be correlated with the inflammatory

condition of amavata. But rheumatoid factor and radiological changes cannot be


56

Amavata

correlated to any conditions of amavata. Hence on symptomatology amavata can

be best correlated to RA.

Pratyatma Lakshana (Cardinal Signs and Symptoms)

Pratyatma Lakshanas are main clinical features on which the disease can

be clearly differentiated from other identical forms of disease. In Amavata,

sandhis are the main site of manifestation of clinical features, thus joint associated

symptoms are considered as Pratyatma lakshana of disease Amavata.

These are as follows:

(a) Sandhi Shoola (Joint Pain)

In Amavata, Vitiation of Asthi and Majjagata Vata causes pain in

Sandhis and in severe stage, it is found as Vrishchika Dansha vata.

The most common manifestation of established R.A. is pain in affected

joints, which is aggravated by movements. During rest and especially early

morning stiffness are also characteristic features of R.A. Pain originates

predominantly from joint capsule, which is abundantly supplied with pain fibres

and is markedly sensitive to stretching or distension (Harrison 1994).

(b) Sandhi Shotha (Joint Swelling)

Sandhi Shotha (Ekangika shotha) results when vitiated dosha afflicts

Twaka, Rakta, and Mamsa in joints 223. Madhavakara has described that shotha

result due to the affliction of Ama and Vata Pradhana Tridosha in joints.

Joint swelling in R.A. is the result of accumulation of synovial fluid,

hypertrophy of synovium and thickening of joint capsule.

(c) Stabdhata (Stiffness)

The restriction or loss of movements of joints. Gatra stabdhata is

caused due to spreading of Ama through out the body by vitiated Vata.224, 225


57

Amavata

In majority of patients, the onset is insidious with joint stiffness,

especially early morning stiffness, which gradually gets reduced by evening. This

diurnal rhythm worse on arising in the morning and than relieving towards

evening probably reflects the diurnal variation in plasma cortisol level.

(d) Sparshasahyata (Tenderness)

Sparshasahyata can be included in Sandhishoola in which patient cries

with pain even when the gentle pressure is applied to affected part. Some times

person himself cannot touch the affected part due to pain.

According to Modern text pain on movement and tenderness are the

cardinal signs of the disease (Becron -1971).

Table-No 9,Lakshans According to different Ayurvedic classics 226,227,228,229,230

No. Lakshana MN B.P. B.R. Y.R. G.N. A.N

1 Agnidourbalya + + - + + - 2 Alasya + + - + + 3 Anaha + + - + + -

4 Angamarda + + - + + - 5 Anga sonata + + - + + - 6 Antra kujan + + - + + - 7 Apaka + + - + + - 8 Aruchi + + - + + - 9 Bahu mutrata + + - + + - 10 Bhrama + + - + + 11 Chardi + + + + + - 12 Daha + + - + + - 13 Gourava + + - + + - 14 Hritgraha + + - + + - 15 Janghadi Pradesha Vyadha - - + - - - 16 Jwara + + - + - 17 Kukshi Kathinyata + + - + - 18 Kukshi sula + + - + - 19 Murcha + + - +

20 Nidra Viparayaya + + - + 21 Pandu Varna - - + - -


58

Amavata

22 Prasekam + + - + + - 23 Sandhi gourava + - - - + + 24 Sandhi Ruja + + - + + + 25 Sandhi shotha + + - + + + 26 Sandhi Graha - - - - - - 27 Sosha - - + - - - 28 Trishna + + + + + - 29 Ushnata - - + - - - 30 Utsaha Hani + + - + + - 31 Vairasyam + + - + + - 32 Vishuchi - - + - - - 33 Vitvibandha + + - + + - 34 Vruschika damsavata peeda + - - - + -

Table No.10, Showing the Sthananusara Laxana

Stanika Laxana Shareerika Laxanas Manasika Laxana Sandhi shotha, Sandhi shoola, Gatra sthabdata, Daha, Raga, Kandu.

Angamarda, Kukshishoola, Aruchi, Bahumutrata, Trusna, Peeta mutrata, Alasya, Takratulyata, Gourava, Nidraviparyaya, Jwara, Antrakoojana, Apaka, Anaha, Agnimandya, Grahanidosha, Praseka, Asyavairasya

Utsahahani, Moorcha, Bhrama, Alasya.

Sapeksha Nidana

Sapeksha nidana becomes necessary when two or more disease have a few

important laxanas similar to each other and in such condition in order to avoid any

error in adopting the line of treatment. The differential diagnostic is done on the

basis of few points such as difference in samprapti accompanying laxanas,

upashaya anupashaya etc.

Here the disesae, which was exhibited with sandhi shotha and

sandhishoola specially, are considered for differential diagnosis.

1) Vatarakta

2) Sandhigatavata

3) Krostaka sheersha


59

Amavata

4) Sandhiga sannipata

5) Sandhi aghata

Vatarakta -

Usually manifests with supti, discolouration and shithilatha of sandhi, pain

is of pricking and splitting nature, sudden onset or disappearance of joint pain.

Anguli sandhies are first affected, then it spread to other parts of the body slowly

like akuvisha, all the affected joints are having pain equally, joint swelling is non

fleeting, no morning stiffness.

Sandhigata vata –

Because of lack of sleshmaka kapha for the friction of joints, it cause pain

and swelling. Here joint movement is accompanied with pain. This is sthira ie.,

non fleeting, the hip and the knee are often affected usually effects middle aged or

elderly persons. Symptoms subside by using sneha therapies.

Krostaka sheersha –

This is the condition, wherein provocated vata and rakta give rise to janu

sandhi shotha and shoola, no other joints are involved. Shotha resembling the

head of jackal, non-fleeting, severe pain in affected joint pain may increase during

night.

Sandhiga Sannipata –

This is a type of sannipata jwara usually manifests due to tridoshakaraka

hetus, swelling and pain of the joints are non fleeting, non variant pain, usually

along with anidrata and severe cough.

Sandhi aghata –

This is of traumatic origin, pain and swelling will be restricted to the

affected joint. Non-fleeting, subsides after few days.


60

Amavata

Types of Amavata

Madhava Nindan while explaining the doshanubandha lakshana 231 he maid 3

types where as while expressing about the sadhyasadhayata of Amavata he maid 7

types on the basis of involvement of the dosas 232 .By combining the above two

points Amavata is of seven types on the basis of dosas they are as given below

1. Vata pradhana -- In this mainly predominance of sula will be present.

2. Pitta pradhana – Daha and Raga are present in the joints.

3. Kapha Pradhana – Staimitya, Gourava & kandhu are the main symptom of

this variety.

4. Vata pitta paradhana – Combined symptoms of both pitta & vata.

5. Vata kapha pradhana -- Combined symptoms of both vata & kapha.

6. Pitta kapha pradhan -- Combined symptoms of both pitta & kapha.

7. Sannipatika -- Combined symptoms of both all dosas.

According to Sharangadhara four types of Amavata are considered

1] Vataja Amavata

2] Pittaja Amavata

3] Kaphaj Amavata

4] Sannipataja Amavata

According to the presence of lakshana Amavata is classified in to two

types first one is Samanya Amavata 233 and second is Pravrudha Amavata234.

According to time period of Amavata it is of two types.

1. Naveena Amavata, 2. Jirana Amavata.

A unique classification of Harita explained in Harita Samhita based on

presentation of the disease. Those are; 235

a) Vistambhi b) Gulmee c) Snehi

d) Pakwama e) Sarvanga


61

Amavata

a) Vistambhi - This presents with constipation, feeling of heaviness, in the

abdomen, flatulence pain in the basti area.

b) Gulmee - Symptoms simulating like gulma, spasmodic pain in abdomen,

increased audible peristaltic sounds.

c) Snehi - Unctonsness of the body, inactivity, loss of appetite, passing of

unctuous and undigested stools.

d) Pakwama - Passing of yellowish, black or dark bluish dehydrated pakwama

through anus, fatigue, exhaustion, condition is not associated with basti shoola.

e) Sarvanga - Pain in kati, prusta and vakshana region, pain in basti, region,

audible peristaltic sound, swelling, heaviness in the head, excessive excretion of

ama are the symptoms.

Upadrava of Amavata

The symptoms of advanced stage of Amavata are considered to be as

Upadrava of Amavata roga. Vacaspati mentioned symptoms of advanced stage of

Amavata are as upadrava but the commentator of Madhakosa Vijayarakshita

differentiates the symptoms of advanced stage of Amavata from Upadrava.

According to him Khanja, Sankocha, occur in Amavata. But further Vachaspati

includes the disease expounded within the title of vata vyadhi under Upadrava. So

it is worth to be considering Angavaikalya is an Updarava considered by Harita.

Even in Madhava Nidhava the Amavata Updravas are mentioned, they are

Trit, Chardi, Bhrama, Moorcha, Hradgraha, Jadya, Antrakoojana, Anaha etc 236.

All the Systems will invalue or get disturbed in the Amavata. It is not

treated in time it produce anatomical deformities like sandhi vikruti and Hrid

Graha. So proper management is must from the on set of disease. The upadrava

depends upon the type of kapha involved in samprapti. If Ama combins with


62

Amavata

shleshka kapha & gets lodged in sandhi sthana creates sandhi vikruti and if Ama

combines with Avalambak kapha resides in Hridaya develops Hrid Graha.

Upashaya / Anupasaya

If the relief occurs by using the Oushandi, Ahara or Vihara are to be

considered as Upasaya. In the oppsite sence if relief not occurs are counted as

Anupasaya 237.

Same types of lakshnas will find in different rogas. If we take example of

Amavata lakshanas such as sandhi shotha, sandhi shool etc, are likely to be found

in other diseases like vatarakta, sandhigatavata, kostakasirsa etc. In this type of

conditions when the lakshanas are found similar to that of another disease it is

difficult to diagnose the disease and adopt the treatment. In this difficult condition

Upashaya and Anupashaya have advised.

Upashaya for Amavata are Ruksha sweda, langhana Usnakala etc Where

as Anupasayas are snigdha sweda, Santarpana etc.

Sadhya Asadhyata 238.

Amavata have got Anubandha with single dosa, naveena avasta, lakshanas

are in mild form, no presence of Upadrava indication of sadhyata of Amavata. If

involvements of any two dosas produce Vyapyata of the Amavata where as

involvement of all the three dosas, involvement of all the joints, Purana Amavata

including with upadravas will become krichra sandhya vyadhi.

Chikitsa of Amavata

Aim of chikitsa is to cure the disease and bring back dosas normal. The

treatment for ‘Ama’ condition is Apatrapana or Langhana. Langhana included

both sodhana and samana. If dosas are alpa langhana is advised. If dosds are

madhyama langhana pachana is indicated. But if dosas are prabhuta sodhana is

advised.


63

Amavata

Regarding with Amavata chakaradatta 239 has explained complete Amavata

chikitsa in first time. The principles of treatment for Amvata are as follows

1. Langhana

2. Swedana

3. Tikta katu deepena drugs

4. Virechana

5. Snehapana

6. Anuvasana and Kshara abasti

7. Ruksha Upanaha 240

8 Sankara sweda 241

1] Langhana

Langhana has advised by Charak in Amasayotaja vyadhi, Rasaja vyadhi

and in Ama vikara. Langhana is of three types Langhana, Langhanapanchana and

Doshavasechana charaka included 10 types in langhana chikitsa which are

Vamana, Virechana, Niruhabasti.Pipasa, Atapa, Pachana, Upavasa & Vyayama 242

Vagbhata classified langhana in to two types Shodhana & Shamana.

In the initial stage of Amavata shodhana is not beneficial when the dosas

are in Sama stage & spread all over the body their elimination is not possible. So

the first aim is to mobilize the doshas from shakha to kostha Upavasa type of

langhana helps in bringing the dosas from Shakha to kostha.

In Amavata there is a predominanace of vata is their but it is in the form of

sam & this langhana (Upavasa) is indicated in samavata that’s why their will be

no any controversy for using langhana in Amavata.

Mainly langhana does Dosha pachana and agnisandhukshana by this the

‘Ama’ present in the Amavata gets digested & gradually Agni will excited their

after.


64

Amavata

2] Swedana

Swedana is the therapy, which relieves the stambha, Gourava, Sheeta &

produces Sweda58. The main symptoms of Amavata are stambha, Gourava, Sheeta

& Shroto avarodha. Where swedana relives these all cardinal symptoms. Usually

by seeing the dosha dooshya samoorchana in Amavata ruksha sweda has been

recommended where as in Nirama conditions snigdha. Due to its heat, causes

relaxation of muscles & tendons & promotes blood circulation, by this local

metabolic process gets activates by this pain gets relief.

If there is involvement of few joints the local types of swedana can be

advised. But if the involvement is of multiple joints Sarvanga swedana should be

advised.

By the help of swedana digestive capacity will increase softness of the

limbs, smoothness and clearness of the skin, relish for food, clearness of the

channels, absence of somnolence & drowsiness and free movement of joints

above this dosas which are moistened by snehana gets liquefy and carried down in

to the kostha 244.

3) Deepana (Tikta & Katu dravyas)

These drugs mainly having the properties like Agnideepana,

Amapachana,245 Avarana dosha Nivarana (Pachana) by these qualities they

acts as Srotosodhaka.

In Amavasta of Amavata, doshas are sticked strongly to srotasa, so they

cannot be removed by snehana and swedana. In such conditions deepana

upakrama will helps to increase the Agni 246 and does Amapachana leading the

detachment of dosha from the Srotases and removal of Srotoradha. It is well

known that Deepana, Pachana is an essential process to be performed in Ama

predominance disease.


65

Amavata

4] Virechana

After the administration of Langana, Swedana, Tikta, Katu and Deepana

drugs, the patient should be subjected to Virechana therapy since the doshas

rendered nirama by these therapeutic measures require elimination from the body

by shodhana. Now the question arises why virechana alone should be given and

not vamana too, because usually vamana precedes virechana. If virechana is given

alone the kapha located in the amashaya may produce mandagni and its

consequences.247 How ever this rule has been relaxed in the case of Udararoga,

gulma etc. The same may also be followed in case of amavata because of the

following reasons.

a) Production of ama is the result of Avarana of pitta sthana by the kledaka

kapha and it is the most suited therapy for the sthanika dosha pitta.

b) Symptom of amavata like anaha, vibandha, antrakujana, kukshishula etc.

are indicative of pratiloma gati of vayu. This is best conquered by

virechana, while vamana is likely to aggravate this condition.

c) Further more, though virechana has been described to be the best remedy

for pitta dosha, yet it is effective in the vitiated kapha and vata dosha also

to some extent. So in this way it appears to be the most appropriate

therapeutic measures in this condition. The use of eranda taila in amavata

suggests that in this disease snigdha and not ruksha virechana should be

employed, since it does not produce generalised snehana effect but by its

snigdha, ushna etc. characteristics, it augments the agni in addition to its

vata anulomana action.

5) Snehapana

Up to the administration of Virechana we are concentrating on the

eradication of Ama. Once Ama digested in the body the other factor which is Vata


66

Amavata

becomes dominant in the body or due to the Apatarpana chikitsa of Ama may

provoca Vata. For this snehapana is advised in Amavata. More over Snehana is

mailnly indicatied in chrinic condtion of Amavata. This Snehapana is used due to

the following benefits which are digestive activity becomes very intense,

Alimentary tract become very clean, by this production of Ama will stop in the

body.

Even after the Shodhna karma, Shamana sneha have advice to retain the

Bala of the Patient.

6] Basti

In amavata both anuvasana as well as Niruha basti have been advocated.

Anuvasana basti removes the dryness of the body caused by amahara treatment,

alleviates vata dosha, maintains the functions of Agni and nourishes the body.

The niruha basti eliminates Doshas brought into kostha by the Langana and allied

therapies. In addition to generalised effect, basti produces local beneficial effects

also by removing the anaha, antra kujana, vibandha, etc. Bruhat Saidhavadi Taila

has been mentioned for anuvasana and ksharabasti for asthapana.

Depending upon the use of different drugs, vasti causes samshodhana and

samshamana effects. Sushruta has stated that the action of basti is mainly due to

veerya. He further elaborates that the drugs used in basti karma will however

spread in the body from pakwashya due to their veerya. So basti karma

eliminates the morbid doshas and dushyas from the entire body by srotosuddhi.

So its effects are tridoshahara.

Its effects are not only limited up to rectum and Samsodhana of malas but

it produces widespread systemic effect. Basti can produce its effect through

medicament effect (Pharmacological effect) and effect of volume (Pressure

effect). Thus with the help of suitable medicaments, vasti therapy may modify


67

Amavata

the colonic physiology and alter pathogenic krimis by prakritivighatana, on the

other hand certain Basti may enrich the normal bacterial flora of the colon and

may be expected to promote their sustaining role in body. By doing so, it

modulate the rate of endogenous synthesis of vit B12, which may have a role to

play in maintanance and regeneration of nerves.

7] Ruksha Upanaha

According to Bhavaprakshana in the Amavata for the local benefit of

Sandhishoola and Sandhishotha this Ruksha Upanaha has advised.248

8] Sankara sweda

In Bhisjjya ratnavali Sankara sweda with making Potali of

Karpasasti, Kulattha, Tila, Yava, Erandamoola, Atasi etc are kept in boiling Kanji

and maid Svedana.249

Various Upakramas have been prescribed by different Acharyas for the

treatment of Amavata as follows:

Table No-11

Sr. Upakrama H.S. V.M. C.D. V.S. B.P. B.R.

1 Langhana - + + + + + 2 Swedana - + + + + + 3 Tikta - + + + + + 4 Katu - + + + + + 5 Deepana dravyas - + + + + + 6 Virechana + + + + + + 7 Snehapana - + + + + + 8 Basti + + + + + +

9 Anuvasana-Saindhavadi Tail - - + - - +

10 Kshara Basti - - + - - +

11 Ruksha sweda by Balukaputa - - + + + -

13 Pachana - - - - - + 14 Vamana - - - - - +

Yoga Ratnakara has followed Bhava Mishra.


68

Amavata

Pathya Apathya.

“If the person is taking Pathya ahara then what is the necessary of taking

medician, if the person is not taking Pathya than what is the necessary of taking

the medicine” this shows the importance of Pathya in the Management of any

disease.

Pathya has important role in the prevention and exacerbation of the

disease process. As per the classics any drug or diet that is katu, tikta by rasa,

Ushna and Teekshna in guna and having vatahara, kaphara, amapachana action is

considered as pathya.

The list of Pathya mentioned in texts;

1. Dravyas - Punarnava, rasna, patola, karavellaka, vartaka, shigru, gokshura,

vriddha daru, ballataka, ardraka (YR), Shyamaka (BP), Varuna, Vastuka (YT)

2. Mamsa - Jangala mamsa rasa (Y.R.B.P), Lavaka mamsa with takra (Y.T)

3. Aharadravya - Puranashali, Yava, Purana Shastikashali, Kulattha

4. Anya - Eranda Taila, Usnodaka, procedures like Rukshasweda, Langhana,

Snehapana, Basti, Lepa, Virechana are considered as pathya. The pathyas of

jwara also considered as pathyas of amavata (HS)

The drugs or diets having guru, picchili, abhishyandhi gunas and which

causes provocation of vata, kapha and formation of ama are considered as

Apathya

All nidanas of amavata are considered as apathya - Masha, Anupamamsa,

Dadhi, Guda, Ksheera, Mathsya, Upodhika, Shimbhi dhanyam, Sheetajalasnana,

Abhyanga considered as apathyas for the disease process.


69

Rheumatoid Arthritis

Rheumatoid arthritis

In Rheumatoid arthritis the onset in majority of the patients is insidious

with joint pain, stiffness & symmetrical swelling of membrane of peripheral

joints. As the disease progresses there is a tendency for it to spread to involve the

wrists, elbows, knees & other joints. The mandibular, acromioclavicular &

sternoclavicular joints are sometimes affected as indeed in every symovial joint.

The history of arthritis is as old as mankind, as the ape-man himself had

arthritis of the spines. Detailed study of this age old, complicated crippling

clinical entity confirms its close association with other branches of medicine such

as neurology, cardiology, endocrinology, bacteriology, geriatrics, pediatrics and

orthopedics.

Rheumatoid arthritis is a chronic disease of the joints, usually

polyarticular, marked by inflammatory changes in the synovial membranes &

articular structures. Hence the knowledge of anatomy & pathophysiology of the

joints is very important, as the synovial joint is involved in Rheumatoid arthritis

this is being elaborated here

Epidomology

Scientists estimate that about 2.9 million people have rheumatoid arthritis

RA occurs in all races & ethnic groups. Although the diseases often begin in

middle age and occur with increased frequency in older people, children & young

adult’s also develop it. Like some other forms of arthritis, RA occurs much more

frequently in women than in men about 2-3 times as many women as men have

the disease. Server RA is found at four times the expected rate in the first-degree

relatives of probands with zero +ves disease.


70


Etiology of Rheumatoid Arthritis: 250 to 255

The disease Amavata is best compared with Rheumatoid arthritis in the

modern parlance.9 Rheumatoid arthritis (RA) is a chronic multisystem disease of

unknown cause. It has been suggested that RA might be a manifestation of the

response to an infectious agent in a genetically susceptible host. Because of the

worldwide distribution of RA, it has been hypothesized that if an infectious agent

is involved, the organism must be ubiquitous. A number of possible causative

agents have been suggested, including Mycoplasma, Epstein-Barr virus (EBV),

cytomegalovirus, parvovirus, and rubella virus, but convincing evidence that these

or other infectious agents cause RA has not emerged. The process by which an

infectious agent might cause chronic inflammatory arthritis with a characteristic

distribution also remains a matter of controversy. Recent work has focused on the

possible role of "superantigens" produced by a number of microorganisms,

including staphylococci, streptococci and M. arthritidis. Super antigens are

proteins with the capacity to bind to HLA-DR molecules and particular Vb

segments of the heterodimeric T cell receptor and stimulate specific T cells

expressing the Vb gene products. The role of super antigens in the etiology of RA

remains speculative. Of all the potential environmental triggers, the only one

clearly associated with the development of RA is cigarette smoking.

Sero positive RA aggregates in families Genetic factors versus their

interaction with environmental facilitators is unclear HLA DR4 is found in 70%

of causascian sero positive patients compared to 25% of controls. Increased

relative risk of 4-5 times for the DR4 positive persons; although a minority are

affected African Americans tend not to exhibit this predilection.11


71


Anatomy of joints:

Synovial joints:

Articulations of the synovial type utilize on entirely different principle

from the non-synovial fibrous and cartilaginous joints. Although the bones

involved are linked together by a fibrous capsule & frequently by accessory

ligaments inside or outside of this, the major parts of the articular surfaces

concerned are in contact but not continuity. They are covered by a relatively thin

stratum of hyaline cartilage (occasionally of fibro cartilage) and the actual contact

is between these cartilaginous surfaces which are characterized by a very low co-

efficient of friction (0.002 or less).

Synovial joints has the following components:

1. A joint capsule that isolates the joint from surrounding tissue.

2. A joint cavity formed by the surrounding joint capsule.

3. A synovial membrane (synoviam) that is the inner lining of the joint capsule.

4. Synovial fluid that is secreted by the synovium & serves as the lubricant &

carries nutrients for the joint.

5. Bones that come together to form the joint.

6. Hyaline (Articular) cartilage covers & protects the ends of the bones that

participate in the joint.

There may be other structures present in or near the joint such as disks,

cartilage (menisci) tendons, ligaments burscea important characteristics of

these structures include.


72


The joint capsule is composed of two layers, an outer fibrous layer & inner

synovium (identified above) the outer layer has many joint receptors innervating

it but is not vascularized. Opposite to it synovium is well vascularized but poorly

innervated. The articualr cartilage has two important functions including the

ability to minimize friction & wear between to opposing joint surfaces during

movement & to dissipute forces on the joint over a wider area. Thus decreasing

stress on the contacting joint surfaces.

Synovial fluid contains hyaluronate (hyaluranic acid) and a glycoprotien

called lubricin. Both are responsible for the lubrication of joint, although they are

specific for certain components. Hyaluronic acid is important for the lubrication

of the joint capsule while lubricin is necessary for cartilage on cartilage

lubrication.

Synovial fluid is also medium by which mutrients are carried to and

wastes are carried from through the avascular components of the joint.

The ends of the long bones that form the synovial joints are composed of

soft spongy type of bone called subchondral bone. Hyaline (articular) cartilage

covers this bone & protects it except for the very ends of the bone, long bones are

usually very strong.

Effects of the disease:

Rheumatoid arthritis can attack any synovial joint in the body. Except the

distal interphalageal joints, it has the greatest affinity for the small joints of hand,

wrist, & foot. In many cases the joint involvement in the limbs becomes relatively

symmetrical. Further, the cervical spine, usually the superior aspect becomes

affected & patients must be watched carefully for disruption of the atlanto axial


73


joint in advanced cases of the disease, subluxation at the atlantoaxial joint can

occur.

Early in the course of the disease several changes in joint structures occur.

Joint effusion & inflammation of the synovium occur producing a soft tissue

swelling that is easily detected during evaluation of the patient. Additionally,

changes in the ends of the bones forming the joints may be present early in the

disease process.

The earlier changes are welling and congestion of the synovial membrane

and overlying connective tissue which becomes infiltrated with lymphocytes,

plasma cells & macrophages. Effusion of the synovial tissue takes place during

the active phase of the disease. Subsequ4ently hypertrophy of the synovial

membrane occurs. Inflammatory granulation tissue or pannus is formed spreading

over & under the articular cartilage, which progressively destroyed. Later fibrous

adhesious may form between the layers of pannus across the joint space & fibrous

or even bony ancylosis may seen. The synovial fluid secreted by the synovium is

thought to save two main purposes, lubrication of the joint & provision of

nutrients to the avascular articular cartilage. In this disease process, an interaction

between antibodies & antigen’s occurs, and causes alterations in the composition

of the synovial fluid. Ultimately, digestants are formed in the fluid, which attacks

the surrounding tissue. Once the composition of this fluid is altered, it is less able

to perform the normal functions noted above and more likely to become

destructive.

The muscles adjacent to inflame its atrophy and there may be focal

infiltration with lymphocytes.


74


The changes in the synovium & synovial fluid briefly described above, are

responsible for a large amount of joint & soft tissue destruction the destruction of

bone eventually leads to laxity in tendons & ligaments under the strain of daily

activities and other forces, these alterations in bone & joint structure result in the

deformities frequently seen in patients with Rheumatoid arthritis considerable

destruction of the joint can occur with pannus invading the subchondral bone.

Bone destruction occurs at areas where the hyaline cartilage & the

synovial lining do not adequately cover the bone. If the disease progress to a more

advanced stage, the articular cartilage may lose its structure & density resulting in

an inability to withstand the normal forces placed on the joint. In these advanced

cases, muscle activity causes the involved ended of the bones to be compressed

together causing further bone destruction. Further the disease can irreversibly

change the structure & function of a joint to the degree that other degenerative

changes may occur.

Especially in the weight bearing joints of the body, this joint destruction

can progress to the degree that joint motion is significantly limited & joints can

become markedly unstable.

Pathogenesis of Rheumatoid Arthritis: 256 to 260

In contemporary medical science, Amavata can be best correlated to

Rheumatoid Arthritis (Y.N.Upadhyaya). It is described as an autoimmune

disorder. The propagation of Rheumatoid Arthritis is an immunologically

mediated event, although the original initiating stimulus has not been clear. One

view is that the inflammatory process in the tissue is driven by T4 helper cells

infiltrating the synovium. Evidence for this includes,

• The predominance of T4 cells in the synovium


75


• The local production of lymphokines by these infiltrating T cells

• Amelioration of the disease by removal of T cells by thoracic duct

drainage or suppression of their function by total lymphoid irradiation.

Since T lymphocytes produce a variety of cytokines that promote B cell

proliferation and differentiation into antibody forming cells. T cell activation may

also produce local B cell stimulation. The resultant production of immunoglobulin

is rheumatoid factor that can lead to immune complex formation. With

consequent compliment activation there will be exacerbation of inflammatory

process by the production of anaphylatoxins and haemostatic factors. This tissue

inflammation is reminiscent of delayed type of hypersensitivity reaction occurring

in response to soluble antigens or microorganisms. It is how ever unclear that

whether this represents a response to persistent exogenous antigens or to altered

auto antigen such as collagen or immunoglobulins.20

Flow chart-2

Pathogenesis of Rheumatoid arthritis

Lucalization of antigen in Joints

Processing by antigen presenting cells

Interaction with T call receptor

Release of immunopotentiating cytokines

Endothelia call activation

Expression of adhesion molecules

Homing of T – lymphocytes


76


IL – 2 production & T cell proliferation

Production of T cell cytokines

β - Lymphocyte proliferation

Local synttesis of antiglolovlin antibodies

Formation of immure complexes

Activation of complement pathway

Neutrophil chemotaxis & cytolysis

Lymphokine production

Macrophage activation.

Release of monokines & other mocyte medictor

Immune complex phagocytosis by neutrophills & Monocytes.

Release of mediators of acute inflamation (Vasoactive amines proteases,

Lenkotrienes, Oxygen radicals, prostaglandins, polypeptides).

Activation of macrophages & chondrocytes.

Pannus formation

Enzymatic destruction of cartilage bone

Acute phase, fever muscle wasting


77


Prodromal symptoms 261,262

Morning stiffness, generalized weakness, mascolo skeletal pain, fatigue,

anorexia, weight loss etc.

Clinical Features:

1. Artichlar 263,264

In the majority of patients the onset is insidious with joint pain. Stiffness

& symmetrical swelling of a number of peripheral joints. Initially the pain may be

experienced only on movement of joints, but rest pain especially early stiffness is

characteristic features.

In typical case the small joints of the fingers & toes are the first to be

affected. Swelling of the proximal but not distal, interphalaugeal joints given the

fiugers a spindled appearance & swelling of metatassophalargeal joints results in

broadening of the forefoot. Fever, weight loss profound fatigue, anorexia &

malaise with out joint symptoms occur less often.

It’s the disease advances there is a tendency for it to spread to involve.

Wrists, elbows, shoulders, knees, ankles, subtarsal midtarsal joints. The

advancement of pathogenesis is bad to muscle atrophy, tendon sheath & joint

destruction results in limitation of joint motion, joint instability with anterior

subluxation of MTP joints in common with ulnar deviation of the fingers in

addition to this lymphadenopwthy, osteoporosis muscle weakness & wasting,

tenosynovitis, bursitis, popliteal cysts, sometimes subcutaneous nodules are

formed. Apart from this scleromalacia, Keratoconjantivitis, scleritis are bound to

occur. Asymptomatrl periconditis, Pl. effusion may occur infrequently. Some of

the characteristic features of Rheumatoid arthritis are:


78


a Hands – spindling of proximal interphalangeal joints & swelling of

metacaspopalangeal joints dorsnm of wrist. Weakness of grip or triggering of

fiugers. Swan – neck and boutonniere fingers. Z – Deformity of the thumbs.

Ulnar deviation of fingers & drop fingers from rupture of extensor tendons.

b Feet – Dorsal subluxation of toes with overriding & callosities may develop.

c Knee joint – Synovial effusion occurs early followed by fixed flexion, orvarus

or valgus deformities. Synovial rupture may lead to release of fluid into

popliteal space calf. Attesnatively effusion may distend popliteal bursa to

produce a bakes’s cyst, synovitis of bursae may occur at other sites.

d Cervical spine – Subluxation of cervical bodies or altantoaxial joint.

E Crycocastynoid joints – May occasionally be affected causing dysphasia,

hoarseness or stridor.

Table No-12 Extra articular features 265,266

Systemic Fever, Weight loss, Fatigue, Susceptibility to infection

Vasculitis Digital arteritis, Unloss Pyoderma ganzdemosm,Mononearitis, multiple Visural artiritis.

Muscaloskeletal Muscle wasting, Tenosynovitis, Bursitis, Osteoporosis

Cwrdiae Pericarditis,Myocorditis, Endocarditis, Conduction defects CoronoryVasculations, Granulomatis arthritis.

Haematological Anamia, Thrombouptosis, Eosimophelia

Pulmonory Nodules, Pl. Effusions, Fibrosing alveolitis, Bronehiolitis, Eapalan’ syndrome Nodules

Sinuses, Fistulae Neurological Cenicalchord, Compression, Newropathies

Occular Episcleritis, Scleritis, Scbromaleria, Sicca syndrome Skin

Pulmar erythema, Psoariasis


79


Infection: Increased frequency in Rheumatoid arthritis

1] Antimelear antibodies in 50%. 2] Elevated CRP, alkaline phospate platelets.

Differential diagnosis:

Rheumatoid Arthritis differentiated from other diseases having similar

features like Joint Pain on the basis of presenting Signs and Symptoms &

biochemical investigations. These diseases are as follows:

1. Gout :

In pathological investigation high serum uric acid level is present.

Response to administration of Colchicine is found in this condition.

2. Osteoarthiritis :-

Radiological appearance differs, absence of subcutaneous nodules and

R.A. factor. In typical case, Heberdon’s nodes appear in relationship to DIP

joints and ESR usually with in normal limits.

3. Polymyalgia Rheumatica :-

In this condition ESR is very high and peripheral joint signs are

minimal. (Onset of Rheumatoid Arthritis in elderly mimic Polymyalgia

Rheumatica)

4. Polyarthritis Nodosa :-

May resemble Rheumatoid Arthritis, but radiological changes are

minimal. Severe systemic symptoms and necrotising vasculitis at early stage of

polyarthritis may be present, but joint erosions and typical Rheumatoid Arthritis

deformity are rare in later stage.

5. Systemic Lupus Erythematosis :-

It is characterized by the presence of numerous autoantibodies,

circulating immune complexes and widespread immunologically determined


80


tissue damage. Chronic inflammatory arthritis and tenosynovitis may lead to

deformities and contractures, but erosive changes are very uncommon.

6. Rheumatic Fever: -

First, attacks are usually under 15 years of age in 70% of case. It is

characterized by flitting type of joint pain and sustained fever. Spindling of

finger joint is rare. Myocarditis, endocarditis and nodules on the different

histological picture are present.

Some other diseases are as follows from which we have to differentiate

the disease Rheumatoid Arthritis.

• Acute Suppurative Arthritis

• Tuberculous Arthritis

• Reiters Syndrome

• Hypertrophic Osteoarthropathy

• Chronic Arthropathy

• Sarcoid Arthritis

• Scleroderma

• Arthritis with Erythema Nodosum

• Spondylitis

• Psoriatic Arthritis

Symptoms of R.A which may require differential diagnosis are – Table No-13

Symptoms Possibilities to be considered Acute or severe pain in one or a few joints

Joint sepsis – fever may be absent Fracture – even without obvious trauma

Unexplained weakness Cervical spine involvement producing cord compression

Unilateral calf swelling Ruptured Baker’s cyst – this is frequently misdiagnosed as a deep venous thrombosis

Painful red eye Scleritis-requires expert opthalmological assessment


81


Complication of Rheumatoid Arthritis:

• Septic Arthritis

• Amyloidosis – The synovium is infiltrated with amyloid protein.

• Systemic Vasculitis

• Spinal Cord Compression

• Felty’s syndrome – Splenomegaly with neutropenia leads to

repeated infections and weight loss known as felty’s syndrome.

Prognosis: 267,268

The course and prognosis in R.A. is very difficult to predict because of

its variability. 25% of the severe patients may have complete remission of

symptoms and fit for all normal activities. 40% of the cases suffer with moderate

type of functional impairment despite exaggeration and remission. 25% may be

more severely disabled and 10% may be severely crippled almost limited to bed.

Prognosis may be very poor in many cases as follows:

1. High titre of rheumatoid factor

2. Insidious onset of the disease

3. More than one year with active phase without any remission

4. Early development of nodules and erosions

5. Extra-articular manifestation

6. Several functional impairment

The median life expectancy of persons suffering with rheumatoid

arthritis is shortened by three to seven years. Factors co-related with early death

include disability, disease duration or severity, glucocorticoid use and age of

onset of disease.


82


Laboratory findings269

Haematology:

Normochromic or hypochromic anemia, which usually occurs in about

22% of females & 11% of males in adult type. The anemia is more marked in

children & occurs in about 60% of patients. The anemia is due to chromic

inflamation.

Erythrocite sedemntation rate :

During active phase the ESR is raised in about 85-95% of cases.

Scrological

RF: +ve in 50 – 60 % of cases.

CRP: +ve in acute phase of the disease.

Radiological :

Intially only soft tissue swelling of joints may be seen, but with

progressive periarticular osteoporosis, narrowing of joint spaces with marginal

erosions & cup & pencil deformities massive bone resorptions develop marginal

sclerosis & osteophyte formation indicate secondary osteo – arthritis.

Diagnosis :

- Clinical picture CRP positive

- Elevated ESR Positive Rh factors


83


Management

1. Relief of symptoms

2. Suppression of active & progressive disease.

3. Conservation & restoration of function in affected joints.

These are achieved by

1. Treatment of the patient’s drug, rest, physiotherapy, surgery.

2. Modification of environment – aids, appliances, housing, occupation, statutory

social benefits.

General treatment

Physical rest, anti inflammatory drug therapy & maintenance exercises is

the corner stones of treatment for exacerbation of Rheumatoid arthritis. The rest

from physical & emotional stress provided by 2 – 3 wks in hospital is usually

sufficient to induce a marked remission of symptoms with out recourse to strict

bedrest. In few patients a period of complete bed rest may be required to induce a

remission. Rest splints can be used to support a particular painful joint to correct

flexion deformities.

Medications: Most people who have Rheumatoid arthritis take medications.

Some medications are used only for pain relief; others are used to reduce

inflammation. Some medications are disease modifying antirhematic drugs

DMARDs are used to try to slow the course of the disease.


84


In articular corticosteroidal injections are given to bring symptomatic

relief. Non-steroidal anti – inflammatory drug therapy is beneficial initial stages,

which has low incidence of side effects.

Chloroquine phosphate or hydroxy chloroquine sulphate, the antimalierials

are used us the initial adjunct to basic therapy.

Auranofin an oral gold compound, pencillamine parentral gold are also

used, prednisolone a corticosteroid is also used in the treatment.

Immunomodulators are also used.

Surgical treatment.

The primary purpose of these procedures is to reduce pain, improve the

affected joints function, and improve the patient’s ability to perform daily

activities.

Surgical decompression & synovectomy are needed when corticosteroids

and physical measures have failed to relieve movement of limbs.


85

Drug Review

Drug Review

As mentioned earlier, a specific line of treatment aiming at samprapti

vighatana is dealt in our classics. It involves deepana, pachana, shodhana and

shamana depending on the strength of dosha and dushya etc. Accordingly in the

present study vaishwanara churna, eranda taila, bruhat saindhavadi taila Anuvasana

basti, Erandamoladi niruha basti . These are discussed in detail in the following pages.

Vaishwanara Churna 270

Vaishwanara choorna is best deepana pachana drug and has properties like

teekshna, ushna, ruchya etc. It is specially indicated in amavata chikitsa along with

adhmana, gulma, parinama shoola and hrdroga. It overcomes mandagni, shula, shotha

and ama symptoms.

The ingredients of vaishwanara choonra are manimantha, yavani, ajamoda,

nagara and haritaki. The properties of individual drugs are tabulated in table no.8

which is given in the following pages.

Eranda Taila 271,272,273,274

As mentioned in chikitsa aspects, sneha virechana is indicated in amavata.

Eranda taila is considered to be the best among the snehas for virechana. Eranda taila

possesses ushna, guru, sara, teekshna, sukshama, picchila and visra gunas. By rasas it

is katu, kashaya, madhura and tikta and is having madhura vipaka. The actions of

eranda tala are found to be srotovishodhana, lekhana, deepana, balya and rasayana.

It has got vatashleshamhara effect and effective in conditions like janga, kati,

urushoola, anaha and vibandha.

The castor oil cheifly consists of ricinoleate of glycerol or tririninolin with a

small quantity of plantin and stearin. The glycerides of ricinoleic acid C17H32

OHCOOH are mainly responsible for the purgative effect.


86

Drug Review

Activity

Oil is a non irritant purgative, when it reaches the duodenum it is decomposed

by the pancreatic juice into ricinoleic acid, which irritates the bowels, stimulates the

intestinal glands and the muscular coat and cause purgation ie., when given by mouth

oil is saponified and free acid is liberated which procues the effect. It acts in 4 to 5

hours causing liquid stools without pain and gripping and has a sedative effect on the

intestine. Ricinoleic acid is absorbed into the blood and tissues. Ricinin is a voilent

irritant of the intestine.

In short, castor oil is one of the cheapest, simplest and most important useful

purgative of the pharamacopiea in all delicate conditions of children and aged people.

Brihat Saindhavadi Taila 275

This taila is considered as an ideal remedy for amavata in the form of basti,

abhyanga and pana. It also gives strength to agni and indicated in major sandhi

shoola conditions.

Contents

Saindhava, gajapippali, rasna, shatapushpa, yamanika, sarjika, maricha, kusta,

shunti, sauvarchala, vida, vacha, ajamoda, yastimadhu, jeeraka, puskaramula, pippali,

each should be 1/2 pala, eranda taila, 1 prastha, shatapuspa kashaya 1 prastha, kanjika

and mastu 2 prasthas each. The properties of individual drugs are tabulated following

page.

Erandamula niruha basti 276

Ingredients are Erandamula, Palasha, Laghupanchamula, Rasna, Ashwagandha,

Atibala, Guduchi, Punarnava, Aragvadha, Devadaru, Madanaphala, Shatahwa,

Hreebera, Priyangu, Pippali, Yashti, Saindhava, Madhu and taila [sneha]

Erandamuladi niruha basti is Vatashamaka.


87

Table No. 14 Showing the Composition and Properties of Vaishwanara Churna

Sl. No.

Drug Latin Name Rasa Guna Veerya Vipaka Doshagnata

Karmukata Prayojyanga

1 Manimantha Sodium chloride Lavana SnigdhaTeekshna

LaghuSukshma

Sheeta Lavana Tridosha Deepana, pachana, vatanulomana

Lavana

2 Yavani Tachyspermumammi

Katu tikta LaghuRuksha

Teekshna

Ushna Katu Kaphavata Shamaka

Rochana, deepana, vatanulomana,

shoolapra shamana

Phala

3 Ajamoda Carum roxburghianum

Katutikta

LaghuRuksha

Teekshna

Ushna Katu Kaphavata shamaka

Vidahi, deepana, vatanulomana,

shoola prashamana, kaphagna

Phala

4 Nagara Zingiber officinale

Katu LaghuSnigdha

Ushna Madhura Kaphavata shamaka

Tripthigna, rochana, deepana,

pachana, vatanulomana,

shothahara

Kanda

5 Haritaki Terminalia chebula

KashayaPradhana

Pancha rasa

LaghuRuksha

Ushna Madhura Tridosha Shothahara, vedana, sthapana,

anulomana, mrudurechana,

deepana, pachana

Phala

88

Table No-15 Showing the Properties of Drugs of Brihat Saindhavadi Taila

Sl.No. Drug Latin Name Rasa Guna Veerya Vipaka Doshagnata Karmukata Prayojyanga 01 Saindhava Sodium chloride Lavana Snigdha

Teekshna Laghu Sukshma

Sheeta Lavana Deepana Pachana Vatanulomana Tridoshahara

Deepana, pachana, vatanulomana

Lavana

02 Sreyasi Piper retrofractum Katu Laghu Ruksha

Ushna Madhura Kaphavata Shamaka

Rochana, deepana, vatanulomana,

Phala

03 Shatapuopa Anethum sowa Katu Tikta

Laghu Ruksha Teekshna


Rochana, Deepana, pachana, anulomana, shothahara

Phala

04 Rasna Vanda roxburghii Katu Guru Ushna Katu Kaphavata shamaka

Vedanasthapana Amapachana Rasayana

Moola

05 Vavanika Trachyspermum amni

Katu Tikta

Laghu Ruksha Teeksha

Ushna Katu Kaphavata shamata

Rochana, deepana vatanulomana

Phala

06 Sarija Sodium carbonate Kshara Laghu, snigdha Sukshma Soumya

Ushna Katu Kaphahara Deepana, pachana, mootrala, shulahara

Kshara

07 Maricha Piper nigrum Katu Laghu Teekshna

Ushna Katu Vata kapha shamaka

Deepana pachana vatanulomana pramathi

Phala

89

08 Kusta Saussurea lappa Tikta Katu Madhura


Ushna Katu Kapha vata shamaka

Deepana, pachana, anulomana

Moola

09 Shunti Zinghibu officinale

Katu Laghu Snigdha

Ushna Madhura Kapha vata shamaka

Truptigna, rochana, deepana, pachana, vatanulomana shothahara amapachana

Kanda

10 Suvacchala Nacl Lavana Vishada Laghu Sukshma

Ushna Lavana Vata nashaka Rochaka bhedaka deepana pachana vibandhahara

Lavana

11 Vida ---- Lavana Laghu Teekshna Ushna Ruksha Vyayayi

Ushna Lavana Vata kapahara Deepana vaanulomana ruchikala shulahara

Lavana

12 Vacha Acorus calaus Katu Tikta

Laghu Teekshna

Ushna Katu Kaphavata Medhya, vedana, sthapana, deepana, triptigna

Moola

13 Ajamoda Carum roxbur giahum

Katu Tikta

Laghu Sukshma Teekshna


Deepana, vatanulomana, shulaprashamana

Phala

14 Madhuka Glycerrhiza glabra

Madhura Guru Snigdha

Sheeta Madhura Vatapitta shamaka

Rasayana, balya medhya, vatanulomana sandhaveerya

Moola

90

15 Jeeraka Cyminum cuminum

Katu Laghu Ruksha

Ushna Katu Kapha vata shamaka

Deepana, pachana vatanulomana shulaprashamana

Phala

16 Puskaramula

Inula raumosa Tikta Katu

Laghu Teekshna


Deepana pachana vatanulomana shotharaha

Moola

17 Kaha Piper longum Katu Laghu Snigdha Teekshna

Anusha Sheeta

Madhura Kaphavata shamaka

Deepana truptigna vatanulomana rasayana balya

Phala

Table No-16 Erandamooladi Vasti Dravyas

Sl. No.

Drug Latin Name Rasa Guna Veerya Vipaka Doshagnata Karmukata

01 Erandamoola Ricinus communis Snigdha,TeekshnaSoukshma

Madhura Madhura Ushna Kaphavata shamaka

Shotahara vayasthapana ballya

02 Palasha Butea monosperma

Laghu Ruksha Katu Tikta Kashaya

Katu Ushna Kaphavata shamaka

Deepana Grahi Anulomana

03 Rasna Pluchea lancioleta Guru Tikta Katu Ushna Kaphavata shamaka

Deepana Rechana Anulomana

04 Bala Sida cardifolia Laghu Snigdha Picchila

Madhura Madhura Seeta Vatapitta shamaka

Vatanulomana Rasoyana

05 Guduchi Tinospora cardifolia

Guru Snigdha Tikta Kashaya

Madhura Ushna Tridoshahara Deepana Ballya Rasayana

06 Ashwaganda Withenia somnifera

Laghu Snigdha Katu Tikta Madhara

Madhara Ushna Kaphavata shamaka

Sothahara Vedanasthapana

91

07 Punarnava Boerhavia diffusa Laghu Ruksha Madhura Tikta Kashaya

Madhara Ushna Tridoshahara Lekhana Sothahar

08 Aragvadha Cassia fistula Guru Mrudu Snigdha

Madhara Madhara Seeta Vatapitta shamaka

Rechana

09 Devadaru Cedrus deodara Laghu Snigdha Tikta Katu Ushna Kaphavata shamaka


10 Madana phala Randia spinosa Laghu Ruksha Kashaya Madhura Katu Tikta

Katu Pabhava Vamana

Ushna Kaphavata shamaka

Vedanasthapana Sothahara

11 Shala parni Disodium Gangiticum

Guru Snigdha Madhura Tikta

Madhura Ushna Tridoshahara Sothahara

12 Prasnaparni Ureria picta Laghu Snigdha Madhura Tikta

Madhura Ushna Tridoshahara Sothahara

13 Gokshura Tribulas terestris Guru Snigdha Madhura Madhura Seeta Vatapitta shamaka


14 Kantakari Solanamsurattense Laghu Ruksha Teekshna

Katu Tikta Katu Ushna Kaphavata shamaka

Sothahara

15 Bruhati Solanum indicum Laghu Ruksha Teekshna


Sothahara

16 Vacha Acorus calamus Laghu Ruksha Teekshna


Sothahara

17 Hapusha Juniperus cmmunis



Vedanasthapana

18 Shatavha Anithum sowa Laghu Ruksha Teekshna



19 Priyangu Callicarpa Macrophylla

Guru Ruksha Kashaya Madhura Tikta

Katu Seeta Vatapitta shamaka


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20 Yastimadhu Glycyrrhiza glebra

Guru Snigdha Madhura Madhura Seeta Vatapitta shamaka

Vedanasthapana

21 Kana Pipper longama Laghu Snigdha Teekshna

Katu Madhura Anushna seta

Kaphavata shamaka

Deepaka Turptighna

22 Vatsaka beeja Holirina antidysentrika

Laghu Ruksha Kashaya Tikta

Katu Seeta Kaphapitta shamaka

Sothahara

23 Musta Cyprus roturdus Laghu Ruksha Kashaya Tikta Katu

Katu Seeta Kaphapitta shamaka

Deepana Pachaka

24 Taksharyashaila Laghu Ruksha Tikta Katu Katu Ushna Kaphavata shamaka


25 Saindhava lavana

Sodium chloride Laghu Snigdha Swadu Madhura Seeta Tridoshahara Deepana Pachaka Ruchya

26 Makshika Laghu Ruksha Madhura Seeta Tridoshahara Lekhana Balya Deepana

27 Tail Guru Madhura Madhura Ushna Kaphavata shamaka

Brhana Lekhana

28 Gomootra Cows urine Laghu Ruksha Kashaya Tikta Katu

Katu Ushna Kaphavata shamaka

Vedanasthapana Sothahara Rechaka

93

Material and Methods

Materials and methods

The materials taken for the study are

1) Vaishwanara churna

2) Eranda taila

3) Bruhat saindhavadi taila

4) Erandamooladi Niruha basti

5) PaciboCapsules

1) Vaishwanara Churna

The ingredients of the churna were manimantha, yavani, ajamoda, nagara and

haritaki are identified correctly and churna prepared with the help of Rasashastra

department.

2) Eranda Taila

Plain eranda taila was purchased and moorchana was done using drugs

haridra, triphla, musta, hrivera, lodhra, vatanukara according to classical method at D

G M A M C Pharmacy and then used for Nittyavirechana purpose.

3) Brihat Saindhavadi Taila

For anuvasana basti Brihat Saindhavadi Taila ingridients are identified, those

are saindhava, gaja pippali, rasna, shatapuspa, yamanika, sarjika, maricha, kostha,

shunti, souvarchala, vida, vacha, ajamoda, yasti madh, jeeraka, pushkaramula, pippali,

eranda taila, shatapuspa kashaya, kanjika and mastu. According to the priparetion of

Sneha Brihat Saindhavadi Taila was maid in D G M A M C Pharmacy and then used

for Anuvasana basti

4) Erandamooladi Niruha basti

All Ingredients of Erandamooladi Niruha basti were identified ( Erandamula,

Palasha, Laghupanchamula, Rasna, Ashwagandha, Atibala, Guduchi, Punarnava,


94


Aragvadha, Devadaru, Madanaphala, Shatahwa, Hreebera, Priyangu, Pippali, Yashti,

Saindhava, Madhu and taila ) and are used to prepare just before administration of

Niruha basti according to the preparation of Niruha basti dravya.

5) PaciboCapsules

Capsules were prepared by filling starch powder.

Diagnosis

The diagnosis will be made on the basis of classical signs and symptoms

mentioned in the Ayurveda and modern texts and criteria laid down by American

Rheumatism Association (1988) following features are employed for confirmation of

RA.

1) Morning stiffness (> = 1hr)

2) Swelling of three or more joints

3) Swelling of hand joints (PIP, MP)

4) Symmetrical swelling

5) Subcutaneous nodules (Rheumatoid nodules)

6) Presence of serum rheumatoid factor

7) Radiological changes (Hands & wrist)

Criteria 1 to 4 must have been continuous for 6 weeks or longer must be

observed by physician. A diagnosis of RA requires that, four of the above seven

criteria should be present.

Research Design

After the diagnosis, as on the above parameters, the selected patients

were assigned for the Comparative clinical trial as follows.


95


Source of data:

Patients suffering from Amavata have selected from P.G.S & R.C.

O.P.D. of shree D.G.M. A.M.C. and Hospital Gadag.

Sample size & grouping:

A minimum sample of 30 patients with Amavata diseases have equally

distributed in two groups.

Group A – 15 patients have received Virechana

Group B- 15 patients have received Yogabasti.

Selection criteria

Patients were selected strictly as per present inclusive and exclusive criteria

a) Inclusive criteria:

1. Classical signs and symptoms will be considered for the selection of patients.

2. Patients of Amavata having the history of less than 5 years.

3. Patients of Amavata between the age group of 20 to 60 years of either sex.

4. Patient fit for Virechana and Bastikarma.

b) Exclusive criteria :

1. Patients of Amavata having the history of more than 5 years.

2. Patients of Amavata less than 20 years and more than 60 years of age.

3. The patient of Amavata having the systemic diseases like Diabetes mellitus,

Asthma, Hypertension, Rheumatic heart disease & Heart diseases etc.

4. Patients unfit for Virechana and Bastikarma.

5. Pregnant and lactating mothers.


96


Study duration

For group A

Nittyavirechana

The patients were administered vaishwanara choorna internally in a

dose of 3 – 6 Gms thrice daily with a cup of hot water, half an hour before food. The

treatment was given till the nirama laxanas were observed. Eranda taila in the quantity

of 15 to 30ml was given in between 8 to 9am when the patient is not so hungry for 8

days for the purpose of Nittyavirechana, according to the kosta of the patient. A cup

of hot water was advised as anupana and Parihara kala was advised for 16 days. In

Parihara kala one Placibo capsules was advised to take daily.

For group B

Yogabasti

The patients were administered Vaishwanara choorna internally in a

dose of 3 – 6 Gms thrice daily with a cup of hot water, half an hour before food. The

treatment was given till the nirama laxanas were observed. After finding nirama

Laxshana Yogabasti has given with Bruhatsaindhavadi taila Anuvasana basti and

Erandamooladi Niruha basti. Parihara kala was advised for 16 days. In Parihara kala

one Placibo capsules were advised to take daily for benefit of good follow up.

Valuka sweda was advised whenever patient complaints increased pain

and stiffness during the course of the treatment for both groups.

Method, Preparation and Administration of Basti

In this study Yogabasti patterned was followed. In this course five anuvasana

basti with Bruhat saindhavadi taila and three Eranadamooladi niruha basti were

administered. The anuvasana basti was given first day after finding Nirama laxshana.

On that morning after evaluation of bowels and bladders patient was advised to take


97


light food (onefourth of his normal quantity). Then the patient was sent to

panchakarma theatre and subjected for local abhyanga and sweda. Then the patient

was asked to lie down on the table in the left lateral position, with the left knee

extended, right limb flexed both at the hip and knee joint and resting on the left knee.

The head was supported by the patient’s left hand. The plastic glycerin enema syringe

with a capacity of 100ml and plain rubber catheter of the size no.12 were used for the

purpose of anuvasana basti the anal orifice and the inserting end of the catheter were

smeared with oil for lubrication. The rubber catheter connected to the enema syringe

filled with brihat saindhavadi taila was gently inserted about 4 inches into the rectum

parallel to spinal column. Simultaneously the patient was asked to take deep breaths;

the catheter was removed with some amount of drug still remaining in the syringe to

prevent the entry of air into the colon. Then the patient was asked to turn into the

supine position, raised his both legs three times and his buttocks were gently patted

and his palms and soles were rubbed. Patient was asked to remain in the same

position for half an hour. Patient was watched for the evacuation of drug. After

evacuation they were allowed to take hot water bath and then light food

The quantity of bruhat saindhavadi taila taken was 80ml; the course of

anuvasana basati was given for alternate days and was ended with two continuous

anuvasana basti.

The niruha basti was started on the second day of the course. The niruha

basti dravya was prepared at the time of administration, first 12 gms of finely

powdered saindhava lavana was taken in the Khalva and was mixed 60 ml of

Makshika with Peshani, than 60ml of Tila tail was taken and churned with the same.

After this 10gm fine powder of Kalka dravya was made paste and well churned with


98


the previous mixture. Finally 400 – 500 ml of Kwatha, which is prepared from

Erandamooladi kwatha choorna, was mixed up to the uniform consistency.

This was filtered and indirectly warmed in a boiling water vessel to make it

Luke warm. The niruha basti was given in empty stomach state in the similar manner

to that of anuvasaha basti. The purva karma and pradhana karma were similar to that

of anuvasana. Plastic enema can with a capacity of 1200ml was taken instead of

enema syringe. Patient was advised to remain in the table till he feels the urge for

defecation. After defecation they were allowed to take hot water bath and then light

food. The quantity of Erandamooladi niruha basti administered was 500-600ml per

each time. Valuka sweda was advised whenever patient complaints increased pain and

stiffness during the course of the treatment.

After completion of Yogabasti 16 days Parihara kala have advised, in this

period placebo Capsule was continued daily once.

Data Collection

All the patients were thoroughly examined by both subjectively and

objectively. Detailed history pertaining to the mode of onset, previous ailment,

previous treatment history, family history, habits, Ashtavidhapareeksha and

Dashavidhapareeksha and physical examination findings were noted. Routine

investigations were done to exclude other pathologies.

Examination of the patient

History – History taking of patient is very important to diagnose the diseases

especially of Amavata patient. When medical history focusing on the pain in the

joints, specific things to discussed when taking the history of a man with Amavata

symptoms include a history of morning stiffness of joints, symmetrical artheitis,

arthritis of more than three joints etc.


99


Inspection – In case of Amavata, joints should be examined by inspection. We can

observe the swelling, redness of joints etc. Even we can observe the deformity of

joints and this can see the gait change.

Palpation – Should be accurate to identify the Jwara, Ushnata of joints,

Sparshasahatwa of joints can be finding by this palpation.

Percussion – It helps to know the Kukshikathinnyata of Udara. It can also be used to

identify the Adhmana and Anilasanga.

Auscultation – It helps in finding the invalment of Hridaya and also helps in the

Adhmana and Anilasanga by hearing the sound like (gudu gudu).

Investigetions and selection of patient

Both objective and subjective parameters were considered for the selection of

patient for both groups

Objective parameters

The below investigations are done before the selection of patient for the study.

1] Hb%

2] E S R

3] A S L O titer

4] C R P

5] Rh factor

Subjective parameters

The subjective parameters taken for this study are

1] Ruja

2] Shotha

3] Stabdata

4] Ushnata


100


The above four criteria ware considered for all the seven joints which are

explained by Madhavakara in his Madhukosha.

Method of assessment

Subjective parameters and objective parameters of base line data to

after treatment data are done for comparison of the assessment of result.

Grading of parameters

Results are calculated by observing Subjective parameters by grading method.

Grading was done as in the bellow manner.

1] Hasta sandhi

Grade 0 = All the Ruja, Shotha, Stabdhata and Ushnata are absent.

Grade 1 = any one of the Ruja, Shotha, Stabdhata and Ushnata was present.

Grade 2 = any two of the Ruja, Shotha, Stabdhata and Ushnata are present.

Grade 3 = any three of the Ruja, Shotha, Stabdhata and Ushnata are present.

Grade 4 = All the four Ruja, Shotha, Stabdhata and Ushnata are present.

2] Pada sandhi


Grade 1 = any one of the Ruja, Shotha, Stabdhata and Ushnata was present.

Grade 2 = any two of the Ruja, Shotha, Stabdhata and Ushnata are present.

Grade 3 = any three of the Ruja, Shotha, Stabdhata and Ushnata are present.

Grade 4 = All four Ruja, Shotha, Stabdhata and Ushnata are present.

3] Gulpha sandhi


Grade 1 =any one of the Ruja, Shotha, Stabdhata and Ushnata was present.

Grade 2 =any two of the Ruja, Shotha, Stabdhata and Ushnata are present.


101


Grade 3 =any three of the Ruja, Shotha, Stabdhata and Ushnata are present.


4] Trika sandhi




Grade 3=any three of the Ruja, Shotha, Stabdhata and Ushnata are present.


5] Janu sandhi


Grade1 =any one of the Ruja, Shotha, Stabdhata and Ushnata was present.




6] Uru sandhi






7] Sira sandhi





102




8] Hb%

The numerical value of Hb% was taken before and after for the assessment.

9] ESR

The numerical value of ESR was taken before and after for the assessment

Overall Assessment of the Treatment

To assess the overall effect of therapy, the criteria laid down by ARA (1967)

were adopted. The results are classified into four groups as listed below.

Grade I - Complete Remission

1 = No systemic sign of rheumatoid activity

2 = No signs of inflammation

3 = No evidence of activity in any extra articular process, including

nodules tinovaginitis and iritis.

4 = No lasting impairment of joint mobility other than that associated

with irreversible changes

5 = No elevation in ESR

6 = Articular deformity or extra articular involvement due to

irreversible changes may be present.

Grade II - Major Improvement

1 = No systemic sign of rheumatoid activity with the exception of an

elevated sedimentation rate and vasomotor imbalance

2 = Major signs of inflammation resolved, such as warmth, redness

of joint structures.


103


3 = No new rheumatoid process of intra articular or extra articular

structures.

4 = Minimum joint swelling may be present.

5 = Impairment of joint mobility associated with minimum residual

activity may be present.

6 = Articular deformity or extra-articular involvement due to

irreversible changes may be present.

Grade III - Minor Improvement

1 = Diminution of systemic signs of Rheumatoid activity.

2 = Signs of joint inflammation only partially resolved

3 = No evidence of extension of rheumatoid activity into additional

articular or extra articular structures.

4 = Decreased but not minimum joint swelling present.

5 = Impairment of joint mobility may be present.

6 = Articular deformity or extra articular involvement due to

reversible changes may be present.

Grade IV – Un improvement or Progression

1 = Undiminished signs of rheumatoid activity, regardless of

functional activity.

2 = Exacerbation of any previously involved joint or joints or

development of sites of rheumatoid activity.

3 = Roentgenologic changes indicative of progression of the

rheumatoid process, excepting hypertrophic changes.

4 = In the presence of 1 or more of the afore said criteria, improvement

in other feature, including a normal or lowered ESR, not significant.


104

Observation and Results


In this present clinical study subjective and objective changes were considered

for the comparative Ayurvedic management of Amavata with

Yogabasti(Erandamooladi Niruha and Bruhatsaindhavadi Anuvasana) and Nittya

virechana with Eranda taila. Thirty patients were selected after fulfilling the criteria

for diagnosis and were treated in the following two groups –

Group A – Yogabasti – 15 patients.

Group B – Nittya virechana with Eranda taila – 15 patients.

All the patients were examined before and after the treatment according to the

case sheet format given in the appendix. Both the subjective and objective changes

were recorded and are presented under the following heading –

Demographic data.

Data related to the disease.

Data related to subjective and objective parameters before and after treatment.


105


Demographic data

Table No.17 showing distribution of patients by age groups.

Group A Group B Age group No % No %

Total

%

20-30 5 33.33 3 20 8 26.66 31-40 4 26.66 6 40 10 33.33 41-50 3 20 4 26.66 7 23.33 51-60 3 20 2 13.33 5 16.66

In Group A – Out of 15 (i.e.50%) patients, 5 patients (i.e.33.33%) were in the

age group of 20-30 years, 4 patients (i.e.26.66%) were in the age group of 31-40

years, 3 patients (i.e.20%) were in 41-50 years age groups and 3 patients (i.e.20%)

were in 51-60 years of age group.

In Group B – Among 15 (i.e.50%) patients, 3 patients (i.e.20%) were in 20-30

years age group, 6 patients (i.e.40%) were in 31-40 years age group , 4 patients were

(i.e.26.66%) were in 41-50 age groups and where as 2 patients were reported in 51-60

years age group.

Graph No.1 showing distribution of patients by age groups

010

2030

4050

Group A Group B Total %

20-30 31-40 41-50 51-60


106


Table No. 18. Showing distribution of patients by Sex

Group A Group B Sex No % No %

Total

%

Male 04 26.66 04 26.66 08 26.66 Female 11 73.33 11 73.33 22 73.33

Among the 15 patients in the Group A, 4 patients (26.66%) were males, in the

same Group, 11 ware females (73.33%). In group B, 4 patients (26.66%) were males,

and females ware 11(73.33%) had moderate response.In the study as a whole (30

patients), 08 males (%), and 22( %)patients ware female.

Graph No. 2. Showing distribution of patients by Sex in both groups

01020304050607080

GroupA

GroupB

Total %

MaleFemale


107


Table No. 19 showing distribution of patients by religion.

Group A Group B Religion No % No %

Total

%

Hindu 14 93.33 13 86.66 27 90 Muslim 01 6.66 02 13.33 03 10

In Group A – Among 15 patients, 14 patients (i.e.93.33%) were of Hindu

religion, 01 patient (i.e.6.66%) were in Muslim community and none of the patient

observed in Christian and other religion.

In Group B – Among 15 patients, 13 patients (i.e.86.66%) were of Hindu

religion, 02 patients (i.e.13.33%) ware of Muslim community and none of the patient

observed in Christian and other religion.

Graph No. 3 showing distribution of patients by religion.

0

20

40

60

80

100

GroupA

GroupB

Total %

HinduMuslim


108


Table No. 20 showing distribution of patients by occupation.

Group A Group B Occupation No % No %

Total

%

HW 10 66.66 10 66.66 20 66.66 Sedentary 02 13.33 00 00 02 6.66 Labor 03 20 05 33.33 08 26.66

In Group A – Out of 15 patients, 10 patients (i.e.66.66) were house wife’s,

02(13.33) patients were sedentary, and in labor group 03 (20%) patients ware

noticed. No patient was observed from occupations.

In Group B – Out of 15 patients, 10 patients (i.e.66.66%) were house wife’s,

no patients ware in sedentary occupation group, 5 patients(ie.33.33) ware observed in

labor occupation group.

Total 20 patients (66.66%) ware house wife’s, 02 patients (6.66%) ware

sedentary and 08 patients (26.66% ) ware in labor group.

Graph No. 4 showing distribution of patients by occupation.

010203040506070

GroupA

GroupB

Total %

HWSedentaryLabor


109


Table No. 21 showing distribution of patients by socio-economical status.

Group A Group B SE status No % No %

Total

%

Poor 08 53.33 08 53.33 16 53.33 M Class 06 40 07 46.66 13 43.33 UM Class 01 6.66 00 00 01 3.33

In Group A – Out of 15 patients, 06 patients (i.e.40%) were in middle class

socio-economic group, 01 patients (i.e.6.66%) were in to high class socio-economic

group and 08 patients (i.e.53.33%) are in poor socio-economical status group.

In Group B – Out of 15 patients, 07 patients (i.e.46.66%) were in middle class

socio-economic group, 08 patients (i.e.53.33%) are in poor class socio-economic

group and 00 patients (i.e.00%) were in high class socio-economical status group.

Graph No. 5 showing distribution of patients by socio-economical status

010

2030

4050

60

GroupA

GroupB

Total %

PoorM ClassUM Class


110


Table No. 22 showing distribution of patients by dietary habits.

Group A Group B D. Habits No % No %

Total

%

Veg. 11 73.33 11 73.33 22 73.33 Mixed 04 26.66 04 26.66 08 26.66

In Group A – Out of 15 patients, 11 patients (i.e.73.33%) were vegetarian and

4 patients (i.e.26.66%) were mixed diet habit.

In Group B – Out of 15 patients, 11 patients (i.e.73.33%) were vegetarian and

4 patients (i.e.26.66%) were mixed diet habit.

Graph No. 6 showing distribution of patients by dietary habits.

01020304050607080

GroupA

GroupB

Total %

Veg.Mixed


111


Table No.23 showing the distribution of patients by duration of disease

Group A Group B DurationNo % No %

Total

%

Less than 1 yr

02 13.33 01 6.66 03 10

>1-<2 05 33.33 05 33.33 10 33.33 >2-<3 04 26.66 04 26.66 08 26.66 >3-<4 02 13.33 02 13.33 04 13.33 >4-<5 02 13.33 03 20 05 16.66

In Group A – Out of 15 patients, 02 patients (13.33) are having less than one

year history, 05 patients (33.33) are having more than one year and less than two year

history, 04 patients (26.66%) are having more than two year and less than three years

history, 02 patients (13.33%) are having more than three year and less than four years

history, 02 patients (13.33%) are having more than four years and less than five years

history.

In Group B – Out of 15 patients, 01 patients (6.66%) are having less than one year

history, 05 patients (33.33) are having more than one year and less than two year

history, 04 patients (26.66%) are having more than two year and less than three years

history, 02 patients (13.33%) are having more than three year and less than four years

history, 03 patients (20%) are having more than four years and less than five years

history. Graph No.7 showing the distribution of patients by duration of disease

05

101520253035

Group A

Group B

Tota

l

%

Less than 1 yr>1-<2>2-<3>3-<4>4-<5


112


Table No. 24 showing the distribution of patients by treatment history

Group A Group B Treatment history No % No %

Total

%

Allopathic 11 73.33 14 93.33 25 83.33 Al & Ay 04 26.66 01 6.66 05 16.66

In Group A – Out of 15 patients, 11 patients (i.e.73.33%) were taken

Allopathic treatment and 4 patients (i.e.26.66%) were taken mixed treatment of both

Allopathic and Ayurvedic.

In Group B – Out of 15 patients, 14 patients (i.e.93.33%) were taken

Allopathic treatment and 01 patients (i.e.6.66%) were taken mixed treatment of both

Allopathic and Ayurvedic.

In this study 25 patients (83.33%) have taken Allopathic medicine, where as

05 patients (16.66%) have received Ayurvedic medicine before this clinical trial.

Graph No. 8 showing the distribution of patients by treatment history

0

20

40

60

80

100

GroupA

GroupB

Total

%

AllopathicAl & Ay


113


Table No. 25 showing distribution of patients by nature of Koshta.

Group A Group B Nature of Koshta No % No %

Total

%

Mridu 06 40 06 40 12 40 Madhyama 03 20 04 26.66 07 23.33 Krura 03 20 03 20 06 20 Sama 03 20 02 13.33 05 16.66

In Group A – Out of 15 patients, 6 patients (i.e.40%) were having Mridu

koshta and 3 patients each (i.e.20%) were reported with Madhyama, Krura and Sama

koshta.

In Group B – Out of 15 patients, 6 patients (i.e.40%) were having Mridu

koshta, 4 patients (i.e.26.66%) has Madhyama koshta, 3 patients (i.e.20%) were of

Krura koshta and 2 patients (i.e.13.33%) has Sama koshta.

Graph No. 9 showing distribution of patients by nature of Koshta.

05

1015202530354045

GroupA

GroupB

Total

%

MriduMadhyamaKruraSama


114


Table No. 26 showing distribution of patients by Jatharagni. (Status of

Jatharagni).

Group A Group B Status of Jatharagni No % No %

Total

%

Manda 06 40 07 46.66 13 43.33 Vishama 03 20 02 13.33 05 16.66 Teekshna 00 00 01 6.66 01 3.33 Samagni 06 40 05 33.33 11 36.66

In Group A – Out of 15 patients, 6 patients each (i.e.40%) were having manda

and Samagni, 3 patients (i.e.20%) were having mandagni and no patient was reported

with teekshnagni.

In Group B – Out of 15 patients, 7 patients (i.e.46.66%) were having

Mandagni, 5 patients (i.e.33.33%) were having Samagni, 2 patients (i.e.13.33%) were

reported with Vishamagni and only 1 patient was with Teekshnagni status.

Graph No. 10 showing distribution of patients by Jatharagni. (Status of

Jatharagni).

0

10

20

30

40

50

GroupA

GroupB

Total %

MandaVishamaTeekshnaSamagni


115


Table No. 27 showing distribution of patients by nature of Mala pravritti.

Group A Group B Mala pravritti No % No %

Total

%

Regular 01 6.66 04 26.66 05 16.66 Irregular 01 6.66 00 00 01 3.33 Constipation 07 46.66 04 26.66 11 36.66 Frequently 06 40 07 46.66 13 43.33

In Group A – Out of 15 patients, 7 patients (i.e.46.66%) were constipated, 6

patients (i.e.40%) were having frequent mala pravritti and only 1 patients (i.e.6.66%)

was having irregular bowel habit.

In Group B – Out of 15 patients, 7 patients (i.e.46.66%) has frequent mala

pravritti, 4 patients (i.e.26.66%) were constipated and no patient was reported with

irregular type of bowel habit.

Graph No. 11 showing distribution of patients by nature of Mala pravritti

0

10

20

30

40

50

Group A

Group B

Tota

l

%

RegularIrregularConstipationFrequently


116


Table No. 28 showing distribution of patients by type of Desha. (Nature of

Habitat).

Group A Group B Type of

Desha No. of Pt.’s % No. of Pt.’s %

Anupa 0 0 0 0

Sadharana 0 0 0 0

Jhangala 15 100 15 100

The place where this study was conducted is in Jangala pradesh. So all the patients

are in Jangala desha habitat.

Graph No. 12 showing distribution of patients by type of Desha. (Nature of

Habitat).

020406080

100120

No. ofPt.’s

% No. ofPt.’s

%

Group A Group B

AnupaSadharanaJhangala


117


Table No. 29 showing distribution of patients by Vyasana. (Addiction).

Group A Group B Vyasana No % No %

Total

%

Tobacco 06 40 04 26.66 10 33.33 Smoking 02 13.33 02 13.33 04 13.33 No habits 07 46.66 09 60 16 53.33

In Group A – Out of 15 patients, 6 patients (i.e.40%) were habituated to tobacco chewing, 7

patients (i.e.46.66%) are no habits and 2 patients (i.e.13.33%) are smokers.

In Group B – Out of 15 patients, 02 patients (i.e.13.33%) are smokers, 4 patients h

(i.e.26.66%) were habituated to tobacco chewing and patients are out of all habits

Graph No. 13 showing distribution of patients by Vyasana. (Addiction).

010203040506070

GroupA

GroupB

Total %

TobaccoSmokingNo habits


118


Table No. 30 showing the distribution of patients by Nidra in both Groups.

Nidra

Group A % Group

% Total %

Sukha 0 0 0 0 0 0

Alpa 10 66.6 11 73.33 21 70

Ati 0 0 0 0 0 0

Vishama 5 33.3 4 26.6 9 30

Among the 15 patients in Group A, 10 patients had alpa nidra (66.6%) and 5

patients had Vishama nidra (33.3%). Among the 15 patients in Group B, 11 patients

had Alpa nidra (73.33%) and 4 patients had Vishama nidra (26.6%). In the study as a

whole (30 patients), 21 patients had Alpa nidra (70%) and 9 patients had Vishana

nidra (30%). No patient reported with Sukha and Ati nidra in this study.

Graph No. 14 showing the distribution of patients by Nidra in both Groups.

01020304050607080

GroupA

% Group % Total %

SukhaAlpaAtiVishama


119


Table No.31 showing the distribution of patients by Deha prakriti in both

Groups.

Deha Prakriti Group A % Group B

% Total %

Vata 2 13.33 1 6.6 3 10

Pitta 0 0 0 0 0 0

Kapha 0 0 0 0 0 0

Vata-pitta 7 46.6 8 53.3 15 50

Vata-kapha 5 33.33 4 26.6 9 30

Pitta-kapha 1 6.66 2 13.3 3 10

Sannipataja 0 0 0 0 0 0

Group A- Out of 15 patients Vata prakriti persons are 2 (ie.13.33), Vatapitta

prakriti persons are 7 (ie.46.66), Vatakapha prakriti persons are 5 (ie.33.33),

Pittakapha prakriti persons are 1(ie.6.66) and in Pitta, Kapha and Sannipatja are

not found.

Group A- Out of 15 patients Vata prakriti persons are 1 (ie.6.66%), Vatapitta

prakriti persons are 8 (ie.53.33%), Vatakapha prakriti persons are 4 (ie.26.66),

Pittakapha prakriti persons are 2(ie.13.33) and in Pitta, Kapha and Sannipatja ware

not found.

Graph No.15 showing the distribution of patients by Deha prakriti in both

Groups.

0102030405060

Vata PittaKap

ha

Vata-pi

tta

Vata-ka

pha

Pitta-ka

pha

Sannip

ataja

Group A%Group B%Total%


120


Table No.32 showing the distribution of patients by Satmya.

Group A Group B Satmya No % No %

Total

%

Sarvarasa sneha

10 66.66 10 66.66 20 66.66

Sarvarasa ruksha

05 33.33 05 33.33 10 33.33

In Group A – Out of 15 patients, 10 patients (i.e.66.66%) are Satmya with

Sarvarasa sneha and 05 patients (i.e.33.33%) are Satmya with Sarvarasa ruksha.

In Group B – Out of 15 patients, 10 patients (i.e.66.66%) are Satmya with

Sarvarasa sneha and 05 patients (i.e.33.33%) are Satmya with Sarvarasa ruksha.

Graph No.16 showing the distribution of patients by Satmya.

010203040506070

Group A

Group B

Tota

l

%

Sarvarasa snehaSarvarasa ruksha


121


Table No.33 Showing the presence of RA factor in both group

Group A Group B RA factor No % No %

Total

%

Positive 05 33.33 05 33.33 10 33.33 Negative 10 66.66 10 66.66 20 66.66

In Group A – Out of 15 patients, 10 patients (i.e.66.66%) are having RA factor

Negative and 05 patients (i.e.33.33%) are having RA factor Positive.

In Group B – Out of 15 patients, 10 patients (i.e.66.66%) are having RA factor

Negative and 05 patients (i.e.33.33%) are having RA factor Positive

Graph No.17 Showing the presence of RA factor in both groups

010203040506070

GroupA

GroupB

Total %

PositiveNegative


122


Table No.34 Showing the presence of ASLO titer in both group

Group A Group B ASLO titer No % No %

Total

%

Positive 02 13.33 04 26.66 06 20 Negative 13 86.66 11 73.33 24 80

In Group A – Out of 15 patients, 13 patients (i.e.86.66%) are having ASLO

titer Negative and 02 patients (i.e.13.33%) are having ASLO titer Positive.

In Group B – Out of 15 patients, 11 patients (i.e.73.33%)are having ASLO

titer Negative and 04 patients (i.e.26.66%) are having ASLO titer Positive.

Graph No.18 Showing the presence of ASLO titer in both groups

0

20

40

60

80

100

GroupA

GroupB

Total %

PositiveNegative


123


Table No.35 Showing the presence of CRP titer in both group

Group A Group B CRP No % No %

Total

%

Positive 07 46.66 10 66.66 17 56.66 Negative 08 53.33 05 33.33 13 43.33

In Group A – Out of 15 patients, 08 patients (i.e.53.33%) are having CRP

Negative and 07 patients (i.e.46.66%) are having CRP Positive.

In Group B – Out of 15 patients, 05 patients (i.e.33.33%) are having CRP

Negative and 10 patients (i.e.66.66%) are having CRP Positive.

Graph No.19 Showing the presence of CRP titer in both groups

010203040506070

GroupA

GroupB

Total %

PositiveNegative


124


Table No.36 Showing the types of Amavata in both groups

Deha Prakriti Group A % Group B

% Total %

Vata 03 20 02 13.33 05 16.66

Pitta 01 6.66 02 13.33 03 10

Kapha 00 00 00 00 00 00

Vata-pitta 03 20 01 6.66 04 13.33

Vata-kapha 06 40 08 53.33 14 46.66

Pitta-kapha 01 6.66 01 6.66 02 6.66

Sannipataja 01 6.66 01 6.66 02 6.66

Group A- Out of 15 patients Vataja Amavata are 3 (ie.20%), Pittaja amavata are

01 (ie.6.66%), Vatakaphaja Amavata are 06 (ie.40%), Pittakaphaja Amavata are

1(ie.6.66), Vatapittaja Amavata are 03(20%), Sannipataja Amavata are 01(6.66%)

and we have not found Kaphaja type of Amavata.

Group B- - Out of 15 patients Vataja Amavata 02 (ie.13.33%), Pittaja amavata

are 02 (ie.13.33%), Vatakaphaja Amavata are 08 (ie.53.33%), Pittakaphaja

Amavata are 00(ie.00%), Vatapittaja Amavata are 01(6.66%), Sannipataja

Amavata are 01(6.66%) and we have not found Kaphaja type of Amavata.

Graph No.20 Showing the types of Amavata in both groups

0102030405060

Group A %

Group B %

Total %

VataPittaKaphaVata-pittaVata-kaphaPitta-kaphaSannipataja


125


Table No. 37 Showing the distribution of patients by Mode of onset in both

Groups.

Mode of Onset Group A % Group B

% Total %

Chronic 11 73.33 12 80 23 76.66

Insidious 4 26.66 03 20 7 23.33

Acute 0 0 0 0 0 0

Traumatic 0 0 0 0 0 0

In the Group A, among 11 patients (73.33%) are haveing chronic onset, 4

patients (26.66%) of insidious onset.

In the Group B, 12 patients (80%) of having chronic onset 03 patients

(ie.20%) are having insidious.

Graph No. 21 Showing the distribution of patients by Mode of onset in both

Groups.

0102030405060708090

GroupA

% GroupB

% Total %

ChronicInsidiousAcuteTraumatic


126


Table No 38 showing distribution of patients by Nidana

Nidana Group AGroup B

Total %

Prakriti virudha 07 08 15 50

Samaya virudha 08 07 15 50

Samyoga virudha 09 08 16 53.33

Virudha chesta 06 06 12 40

Avayama 04 06 10 33.33

Ativyayama 03 02 05 16.66

Vyaaftersnigdha bhojana 04 05 09 30

Gurubhojana

12 12 24 80

Mandagni 13 11 24 80

Out of thirty patients 15 patients(50%) are having Prakritivirudha nidana and

Samayavirudha nidana, 16 patients(53.33%) are having Samyoga virudha nidana, 12

patients(40%) are having Virudha chesta nidana, 10 patients(33.33%) are having

Avyayama nidana, 05 patients (16.66%) are having Ativyayama nidana, 09 patients

(30%) are having Vyayama after snigdha bhojajna and 24 patients (80%) are having

Gurubhojana and Mandagni.

Graph No 22 showing distribution of patients by Nidana

0

10

20

30

40

50

60

70

80

90

Group A Group B Total %

Prakriti virudha

Samaya virudha

Samyoga virudha

Virudha chesta

Avayama

Ativyayama

VyaaftersnigdhabhojanaGurubhojana

Mandagni


127


Table No.39 showing the distribution of symptoms of Amavata in both Groups.

Symptoms Group A % Group B

% Total %

Sandhi sotha 15 100 15 100 30 100

Sandhi shoola 15 100 15 100 30 100

Sandhi stabdata 15 100 15 100 30 100

Sandhi ushnata 15 100 15 100 30 100

Jara 07 46.66 06 40 13 43.33

Angamarda 13 86.66 11 73.33 24 80

Aruchi 11 73.33 13 86.66 24 80

Apaka 08 53.33 09 60 17 56.66

Trishna 06 40 07 46.66 13 43.33

Alassya 13 86.66 10 66.66 23 76.66

Bahumootrata 05 33.33 04 26.66 09 30

Hrillasa 03 20 04 26.66 07 23.33

Gourava 12 80 13 86.66 25 83.33

Chardi 02 13.33 01 6.66 03 10

Bhrama 04 26.66 02 13.33 06 20

Nidraviparyaya 08 53.33 06 40 14 46.66

Kostabaddata 06 40 08 53.33 14 46.66

Out of 30 patients all 30 patients(100%) are having Sandhishotha,

Sandhishoola, Sandhistabdata, Sandhiushnata, 25 patients(83.33%) are having

Gourava, 24 patients(80%) ware having Angamarda and Aruchi, 23 patients(76.66%)

ware having Alassya, 17 patients(56.66%) are having Apaka laxshana, 14

patients(46.66%) are having Nidraviparyaya and Kosthabadhata, 13 patients(43.33%)

ware having Jvara and Trishna, 09 patients(30%) are having Bahumootrata, 07


128


patients(23.33%) are having Hrillasa, 06 patients(20%) are having Bhrama, 03

patients(10%) are having Chardi Laxshana.

Graph No.23 showing the distribution of symptoms of Amavata in both Groups

0

20

40

60

80

100

Group A % Group B % Total %Sandhi so tha Sand hi shoo la Sand hi s tab data Sandhi ushnata JaraAng amard a Aruchi Apaka Trishna AlassyaBahumo otrata Hrillasa Gourava Chard i BhramaNid ravip aryaya Ko stab add ata

Table No. 40 Showing the over all effect of treatment in both Groups.

Result Group A % Group B

% Total %

Complete

remission

00 00 00 00 00 00

Major

improvement

01 6.66 06 40 07 23.33

Moderate

improvement

11 73.33 09 60 20 66.66

Mild

improvement

03 20 00 00 03 10

Over all effect of treatment in both group:

Comparison of the overall effects of the treatment in both the groups reveals

that Yogabasti is more efficacious. Major improvement of the illness was observed in

06(40% ) of the patients in Yogabasti group as against 01(6.66%) of the patients in

Nittyavirechana group. 09(60%) of the patients in Yogabasti group recorded moderate


129


improvement, where as 11(73.33%) patients have show moderate improvement in

Nittyavirechana. 03(20%) of the patients showed minor improvement in

Nittyavirechana.

From the foregoing it is clear that both Yogabasti and Nittyavirechana are very

effective in the patients suffering from Amavata

Graph No. 24 Showing the over all effect of treatment in both Groups.

01020304050607080

Group A %

Group B %

Total %

CompleteremissionMajorimprovementModerateimprovementMild improvement


130

Data related to the response of treatment

Table No 41 showing Data related to the response of treatment in group A

Hasta Pada Gulpha Trika Janu Uru Sira Hb% ESR S OPD BT AT BT AT BT AT BT AT BT AT BT AT BT AT BT AT BT AT

1 2322 3 2 2 1 3 1 2 1 3 2 1 1 0 0 11.5 11.6 50 30 2 2451 2 1 4 2 3 2 2 1 2 1 1 0 1 0 10.6 10.8 35 20 3 2515 4 2 2 0 2 1 2 1 3 1 1 0 1 0 9.00 9.33 39 15 4 2475 2 0 4 2 3 2 2 1 3 1 0 0 0 0 10.3 10.6 80 35 5 4595 3 1 2 0 3 1 2 1 3 1 2 1 1 0 9.00 9.00 43 20 6 65 2 0 3 1 4 2 1 0 4 2 1 0 0 0 8.5 8.8 28 16 7 987 4 1 2 1 3 1 1 0 4 2 2 1 1 1 9.4 9.5 74 31 8 1106 2 0 4 2 3 2 2 1 2 0 2 1 1 0 9.8 10.1 99 48 9 1233 4 2 3 1 2 1 2 1 2 0 1 1 0 0 8.3 8.7 92 70 10 1240 2 2 3 2 4 2 1 0 4 2 2 1 0 0 7.92 8.4 82 30 11 1567 4 3 2 1 3 1 2 1 2 1 1 0 1 0 11.3 11.8 26 10 12 1742 3 1 2 2 3 1 2 1 1 0 2 1 0 0 10.23 10.8 28 30 13 94 2 0 3 2 4 2 2 2 2 2 1 1 0 0 8.21 8.61 29 11 14 1112 4 1 2 1 3 2 2 0 3 1 2 0 1 1 8.71 8.92 44 15 15 700 2 1 4 1 4 2 2 1 4 2 1 1 0 0 9.8 10.61 53 20

131

Table No 42 showing Data related to the response of treatment in group B

Hasta Pada Gulpha Trika Janu Uru Sira Hb% ESR S OPD BT AT BT AT BT AT BT AT BT AT BT AT BT AT BT AT BT AT

1 3703 3 1 2 1 3 1 1 0 2 1 1 0 0 0 9.6 9.8 70 30 2 2874 2 0 2 0 2 1 2 1 3 1 1 0 0 0 11.2 11.3 55 46 3 3081 4 1 2 1 2 1 2 0 2 1 0 0 1 0 9.3 9.5 32 20 4 2661 1 0 4 1 3 1 2 1 0 0 1 0 0 0 8.4 8.7 28 21 5 2694 3 1 0 0 2 0 1 1 1 0 1 0 1 1 10.7 10.9 39 28 6 2691 1 0 3 1 2 1 2 1 1 0 1 0 0 0 10.2 10.3 40 34 7 2556 1 0 2 0 1 1 1 0 2 0 1 0 1 0 10.7 11 78 30 8 2512 4 1 1 0 2 1 2 1 3 1 0 0 0 0 8.2 8.4 55 34 9 2492 2 0 1 0 2 1 2 1 1 0 1 0 1 0 8.7 8.9 28 19 10 2640 4 2 2 1 2 1 1 0 2 0 0 0 0 0 11 11.4 63 28 11 2633 1 0 4 2 3 1 2 1 2 1 1 0 0 0 10.1 10.3 74 23 12 2690 3 2 2 0 2 1 1 0 2 1 0 0 1 0 9.6 9.7 28 15 13 753 2 0 3 1 4 1 2 0 4 2 2 1 0 0 10.4 10.6 55 24 14 2213 2 1 3 1 3 1 1 0 2 1 0 0 1 0 11.4 11.7 67 30 15 4085 4 1 2 1 2 0 2 0 4 2 1 0 1 0 9.3 9.6 96 42

132

[2]Table No 43 showing statistical analysis of subjective and objective parameters in group A

Sno

Parameters

Mean

SD

SE

T value

P value

Remarks

1

Hasta

1.8

0.774

0.2

9.00

< 0.001

HS

2

Pada

1.533

0.743

0.191

8.026

< 0.001

HS

3

Gulpha

1.466

0.743

0.191

7.67

< 0.001

HS

4

Trika

1.133

0.516

0.133

8.518

< 0.001

HS

5

Janu

1.133

0.617

0.159

2.183

< 0.001

HS

6

Uru

0.666

0.487

0.125

5.328

< 0.001

HS

7

Siro

0.4

0.057

0.130

3.076

< 0.001

HS

8 Hb% 0.22

0.086

0.022

10.00

< 0.001

HS

9 ESR 25.8 17.78 4.59 5.620 < 0.001 HS

133

Table No 44 showing statistical analysis of subjective and objective parameters in group B (table3)

Sno

Parameters

Mean

SD

SE

T value

P value

Remarks

1

Hasta

1.733

0.798

0.206

8.412

< 0.001

HS

2

Pada

1.533

0.743

0.191

8.026

< 0.001

HS

3

Gulpha

1.6

0.506

0.131

12.213

< 0.001

HS

4

Trika

1.00

0.377

0.097

10.309

< 0.001

HS

5

Janu

1.666

0.487

0.125

13.328

< 0.001

HS

6

Uru

0.8

0.5606

0.144

5.55

< 0.001

HS

7

Siro

0.333

0.487

0.125

2.666

< 0.001

HS

8 Hb% 0.313

0.172 0.044

7.11

< 0.001

HS

9 ESR 27.466 14.38 3.714 7.39 < 0.001 HS

134

Table No 45 showing the comparative statistical analysis of subjective and objective parameters in both groups (table 1)

Parameters

Mean

SD

SE

PSE

T value

P value

Remarks

A 0.666 0.723 0.186 Hasta B 1.133 0.915 0.236

0.301 1.551 > 0.05 NS

A 0.6 0.632 0.163 Pada B 1.266 0.703 0.181

0.243 2.74 < 0.02 HS

A 0.866 0.351 0.090 Gulpha B 1.533 0.516 0.133

0.161 4.14 < 0.001 HS

A 0.466 0.516 0.133 Trika B 0.8 0.560 0.144

0.196 1.704 > 0.05 NS

A 0.733 0.703 0.181 Janu B 1.133 0.743 0.191

0.263 1.520 > 0.05 NS

A 0.0666 0.258 0.066 Uru B 0.4660 0.516 0.133

0.148 2.698 < 0.02 NS

A 0.0666 0.258 0.066 Siro B 0.133 0.351 0.090

0.112 0.598 > 0.05 NS

A 10.14 1.012 0.263 Hb% B 9.846 1.156 0.298

0.397 0.74 > 0.05 NS

A 28.066 8.647 2.232 ESR B 26.73 15.8 4.080

4.65 0.287 > 0.05 NS

135


Statistical conclusion

To compare the mean effect of two groups we used unpaired t test by

assuming that the mean effect of two groups is same in all the parameters.

From the analysis the parameter Gulpha, Pada, Uru shows highly significant

than other parameters shows not significant after the treatment [from table No 43] ie p

< 0.05

The parameter Gulpha shows highly significant than other parameters, in

group B the mean effect is more with more variation after the treatment [ by

comparing t value, mean and S.D.]. The effect on Pada and Uru shows equal highly

significant [by comparing P value and t value]

The mean effect of Pada and Uru in group B is more with more variation after

the treatment. Both the objective parameters Hb% and ESR shows not significant as P

is greater than 0.05.

The mean effect of objective parameters Hb% and ESR is more in group A

with less variation after the treatment by comparing mean and standard deviation

Individually the group B shows more significant than group A in parameter

Gulpha, Trika, Janu, Uru & ESR. For this we used paired t test by assuming that the

drug is not responsible for change in the observations before & after the treatment.

In group A the parameter Hastha, Sira & Hb% shows more highly significant

than group B (by comparing p value & t value from table 44 & 45).


136

Discussion

Discussion

Amavata is chronic progressive systemic disorder that mainly targets to

locomotors system. It is named after two major involvements of two pathogenic

factors Ama and Vata, which mainly affects Sandhi. The classics had explained the

manifestation of disease and its treatment. Madhavakara was the first person who

explained this disease as a separate entity. Chakradatta and Vangasena have

contributed its treatment.

This disease occurs in all ethnic groups. Mainly it is more prevalence in urban

area. Sandhishoola, Sandhishotha, Sandhistabdata and Sandhiushnata are the cardinal

clinical features of this disease, apart from this it has many general symptoms like

Gourava, Aruchi, Jvara, Angamarda, Apaka etc are seen in this disease. Though ama

and vata are chief pathogenic factors, kapha and pitta are also invariably involved in

the pathogenisis of Amavata.

To the fact this disease is manifested due to unwholesome diet and regimen

and hypo function of Agnis also an important factor for the initiation of disease

process. The samprapti of this disease originated from Annavaha srotas and

madhyama roga marga with invalvment of sleshma sthana first it affects, later it

affects other sthanas like Sandhi, Asthi, Majja etc. Rasa, Asthi and Majja are

primarily involved dushyas, later it affects mamsa, snayu and khandara

The ayurvedic line of treatment explained by ancient acharyas mainly depends

up on the stages of disease. The treatment includes Langhana, Deepana, Amapachana,

Shodhana and Shamana associated with bahirparimarjana like valukasweda.

Deepana and Amapachana help to check the formation of ama and to start

samprapti vighatana. Then the vitiated doshas can be eliminated by virechana and


137

Discussion

basti. After that shamana treatment should be followed to alleviate the remaining

doshas. Valuka sweda can be utilized as a bahirparimarjana chikitsa.

Amavata v/s Rheumatoid arthritis

The disease Rheumatoid arthritis is identical with the signs and symptoms

of Amavata. It always challenge to the physicians due to its chronicity, complication

and morbidity, because of the lack of precise knowledge pertaining to its

etiopathogenesis. Various theories try to explain its etiopathogenesis like hereditary,

Neurogenic, vascular, infective, metabolic, endocrinal, autoimmune and psychogenic.

Though other theories are not yet discarded the autoimmune mechanism is most

commonly implicated.

This disease mainly affects the musculo skeletal system. It has also extra

articular manifestations affecting cardiovascular, nervous and excretory systems,

which is collectively known as connective tissue or collagen disorder. Recently some

of the authors emphasize the Arthritis of entropathy, which is similar with Amavata.

Ama originated in Amashaya and circulates through out the body with vitiated

vata dosha. The ama visha is further increased by interaction of dosha, dushya due to

localized concentration of Amavisha. The contribution of srotovaigunnya as well as

kleda is very much important in the pathogenesis of Amavata. Srotorodha in general

can be compared with rheumatoid vasculitis one of the serious extra articular

manifestation. These sequential steps in the samprapti of Amavata are quite identical

with the etiopathogenesis of Rheumatoid Arthritis. The altered activity of the immune

system, stimulated by exogenous or endogenous antigens probably viral or bacterial in

origin, causes formation of Rheumatoid factor and antibodies. The recent studies

showed that Rheumatoid Arthritis has not been link to any infection, despite of it

resembles to infectious Arthritis [Rheumatic fever].


138

Discussion

Several components of the immune system appear to contribute to the

pathogenesis of Rheumatoid Arthritis. The integral role performed by vascular

endothelium, circulating memory T- cells, tissue macrophages, plasma cells,

Rheumatoid factor and cytokines are initiating and perpetuating Rheumatoid Arthritis

inflammation in the joints and throughout the body. The altered immune mechanism

in Rheumatoid Arthritis can be correlated with the role of Ama in Amavata. The

production of Srotoabhishyanda and kleda is nothing but the inflammatory changes in

Rheumatoid Arthritis. Once again the etiological factor is much similar with Amavata

and the site of the disease is much identical with sleshma sthana and connective

tissues.

As already told the despite years of intensive study the etiology of Rheumatoid

Arthritis is still not known the uncertainties in the etiopathogenesis of this disease

impeded the exploration of an effective treatment or its prevention. In spite of

available treatment, it cripples the ailing for the rest of his life; moreover it affects the

younger and middle-aged people, substantially hampering the economy of the nation.

Thus the disease has posed great challenge to the physicians who are engaged in

research work yet the goal of curing the disease remains long away off.

Line of treatment, which is explained in Ayurveda, can reduce pain, swelling,

protection of joints and control the disease progression. The early invention in

Ayurvedic field helped to prevent the development of disabilities and preferable

respond to this disease. Ayurvedic treatment can give the fitness to participate in the

routine activities of daily living and ambulation, with this aim the present study was

under taken to evaluate and compare the effect of Nittyavirechana and Yogabasti in

Amavata.


139

Discussion

Study method:

In the present study, 33 patients of Amavata were registered, in which 30

patients completed the course of the treatment. The disease was diagnosed on the

basis of signs and symptoms as described in Ayurvedic and Modern texts, aided by

A.R.A. criteria (1988). RA factor test was done in all the patients. Routine Blood,

Urine, Stool examination along with S. uric acid were done to rule out other

pathological conditions.

The selected patients were randomly divided into following 2 groups.

Nittya virechana group: 15 patients were treated in this group with by giving 15-30

ml of Eranda taila for 8 days.

Yogabasti group: 15 patients were treated in this group with Yogabasti karma.

For the assessment of the results guideline laid down by classical text of

Ayurveda as well as parameters suggested by A.R.A. (1988) were followed. The

results obtained were statistically analyzed and percentage of relief, Mean, S.D., S.E.

t-value and P-value were calculated by using the paired t-test.

Materials and methods

Based on the principles of treatment following drugs were selected for the study.

1) Vaishwanara choorna for amapachana

2) Eranda taila for virechana

3) Brihat saindhavadi taila for anuvasana

4) Erandamooladi for niruha basti

Vaishwanara Churna

It is a good deepana and pachana drug indicated in amavata adhikara. It checks

the formation of ama by increasing the agni and digests the ama which is already


140

Discussion

formed. It helps to attain niramavastha, and prepare the body environment for further

shodhanadi treatment.

Eranda Taila for Nittyavirechana

Eranda taila is considered as the best medicine in the management of amavata,

which is used for Nittyavirechana. Because of its sukshma guna it reaches the minute

srotas as and it liquifies the stagnated doshas by its lekhana, usna, teekshna, properties

then it removes by its virechana action. It acts as vatanulomana, it pacifies vata by its

madhura vipaka, snigdha and ushna gunas. It removes the obstruction of vata

produced by ama and kapha and checks the further accumulation of vata in the body

by sroto vishodhana guna.

Probable Mode of Action of Nittyavirechana :

In the present study, Nittyavirechana was administered by Eranda taila. Eranda

taila is Vata-kaphashamaka having specific vyadhihara i.e. Amavatahara action. Ricin

present in it gets converted to Ricinoelic acid by lipase, which irritates bowel leading

to Virechana as it is having Ushna virya, it also does Pachana karma (Amapachana).

Action of Nittyavirechana on Amavata can be understood by the following properties

of it.

Nittyavirechana helps in eliminating the Ama which forms everyday due to

Mandagni in Amavata.

As told in Astanga sangraha when Prakupita doshas are their, it is better to

eliminate little by little in consecutive days.

Nittyavirechana acts as Rasayana, by this patients gets good Bala due this Roga

bala will come down

Virechana has direct effect on Agnisthana and hampered agni (Mandagni) is one

of the initiating factors in Amavata. It pacifies the vitiated Kapha and Vata dosha.


141

Discussion

It has the property of Srotovishodhana, hence the Srotorodha (Srotoabhishyanda)

present in the disease Amavata mainly in Sandhisthana is cleared by

Nittyavirechana leading to relief of the symptoms.

Virechana is indicated in Sannipaitik condition of morbidity (B.S.) and hence

helpful in the disease Amavata.

Virechana works well by clearing the morbid doshas, which adhere to Bahya

(Rasa etc.) and Madhyama (Marma-Asthi-sandhi) Roga Marga with the tiyaka

gamana.

Nittyavirechana helps to normalize the pratiloma gati of vata, which produces

symptoms like Anaha, Antrakujana, Kuskshikathinya, Kukshishoola etc. in the

disease Amavata.

Acharya Charaka has given brief description of how Virechana dravyas acts in

the body:

The drug here Eranda taila having Ushna-tikshna-sukshma guna reach to the

heart by virtue of their potency and circulate through the large and small srotasa and

pervade the entire body. Then they liquefy the morbid elements by virtue of its

Agneya guna and disjoins them by its tikshna guna. Then this liquefied morbid mass

floating like honey in uncted vessels through the virtue of Anu pravanbhava of the

drug and ultimately reaches Amashaya. From here it forces the morbid factors

through the anal canal root due to the Bhautika predominancy of the Jala and Prithvi

and Adhobhagahara prabhava (Ch. K. 1/4) leading to Virechana.

Bruhat Saindhavadi Taila

Which is indicated in amavata and used for anuvasana basti as a poorvakarma

for niruhabasti so that it prepare the kosta by its snigdha gunas to receive Niruhabasti.


142

Discussion

Taila mainly possess katu, tikta, lavana and madhura as rasas, laghu, teekshna ruksha,

snigdha, sukshma, guru and vyavayi as guna, ushna in veerya, katu in vipaka.

Most of the drugs show deepana, pachana, vatanulomana and shothahara

properties. All the drugs have vatahara and shushma guna and are especially

beneficial in amavata. This taila was prepared taking eranda taila as base.

Erandamooladi niruha Basti

The shodhana therapy is a must to treat the disease amavata successfully.

Among the shodhanas, basti is said to be ideal as it pacifies both ama and vata.

Astangasangrahakara Vagbhata has appreciated the role of Erandamooladi niruhabasti

in the treatment of Kaphavata disorders like amavata.

Probable Mode of Action of Yogabasti

The ingredients of Erandamooladi niruha basti mainly possess deepana,

pachana, ushna, sukshma, laghu, ruksha, snigdha, teekshna and lekhana gunas. These

gunas helps to alleviate ama and vata in the body.

In the disease process of amavata, we find the laxanas of avarana vata in the

joints, because of obstruction to flow of vata by ama. The main seat of vata is

pakwashaya, hence the eliminative therapy is directed to pakwashaya. After the

administration of basti, the basti dravya is retained only for a limited period in

pakwashaya. Even then it can be assumed from the effect produced that, the

essentials are absorbed into the system.

The drugs analysis of Erandamooladi niruha basti shows that many

drugs of them have deepana and pachana guna, which directly influences the kostagni

and thereby dhatagni which in turn leads to pachana of already existing ama and

checks the further production of ama.


143

Discussion

It reaches the various parts of the body like sandhis and minute channels like

by its sukshma guna and liquifies the doshas which was present in various forms.

Liqification of them is caused by ushna, teekshna lekhana gunas which in turn

decreases the sroto abhishyandana, meanwhile usna and snigdhata guna of the content

pacifies the vata. Gomutra, which is the chief content, is helpful to reduce the shotha

and ruja as it is mainly indicated in ama.

Erandamooladi niruha basti action is seen up to minute channels, where it does

the lekhana of collected ama and kapha resulting in their liquefaction, which

decreases the abhishyandi, picchila, guru etc. gunas of ama. At the same time it does

the srotovishodhana there by decreasing the srotobhishyandana which inturn leads to

vatanulomana because of removal of obstruction and finally expels ama and kapha

vata out of the body.

Brihat saindhavadi taila given along with it does the above said functions as it

contains drugs having similar properties and pallets vata by snehana guna. The

combined action of these two drugs helps in samprapti vighatana.

As all the drugs of Erandamooladi niruha basti have sufficient qualities

through which they can combat the ama, vata and kapha, it seems logical to say that a

combination of these drugs can be a potent procedure to treat amavata.

But the question is how these drugs are absorbed into the system. None of the

research wear conducted conclusively to solve this question. But here the difficulty

arises in understanding the mode of their absorption and efficacy when administered

in the form of basti but in one interesting quotation Parashara says;

mulam gudam shareerasya sirasthatra prathi stithaha

sarvam shareeram pusnanthi murdhanam yavadashritaha (Ch.Si.4)


144

Discussion

This reference says the importance of guda and how it nourishes the other

parts of the body through its siras.

The rectum has a rich blood and lymph supply and drugs can cross the rectal

mucosa like the other lipid membranes, thus, unionized and lipid soluble substances

are readily absorbed from the rectum the portion absorbed from the upper rectal

mucosa is carried by the superior haemorrhoidal vein into the portal circulation,

where as that absorbed from the lower rectum enters directly into the systemic

circulation via the middle and inferior hemorrhoidal vein.

Even though it is difficult to draw a conclusion regarding the mode of action

of basti, according to the modern pharmacokinetics, the classical literature of

ayurveda provides certain concepts, which facilitates one to understand the mode of

action based on ayurveda principles.

The significant improvement in Shoola, Shotha, Stabdata and Ushnata

changes in the basti group when compared to the Nittyavirechana group justifies that

basti is a more efficient treatment for amavta. Basti has got both doshapratyanika and

vyadhi pratyanika effect on the disease Amavata.

Discussion along with the argument of results obtained is as follows:

General Description of Patients: General description of the patients studied in the

present series was as follows:

Age: All the 33 patients registered for the present study were ranging from 20 to 60

years, of which maximum patients (33.33%) were between 31 to 40 years age group,

which was followed by 26.66% patients in the age group of 20 to 30 years.

Observations of this study were in accordance with the findings of Rheumatoid

Arthritis in middle age (Price and Davidson).


145

Discussion

Sex: In this study majority of the patients were female (73.33%) as compared to

male patients (26.66%). Textual references also reflects the predominance of

Rheumatoid Arthritis in females

Religion: Majority of the patients in this series were Hindus (90%), which may be

due to predominance of Hindu community in this particular region.

Occupation: Most of the women registered were housewives i.e. 66.66%, which

reflects the general occupation of majority of the females in this area.

Economical Status: Majority of the patients i.e. 53.33% in this series were belonging

to poor economic status, while rest of the patients(43.33%) were belonging to middle

class and upper middle class (3.33%) economic status. It may be due to the fact that,

this study was conducted in a general hospital, where free treatment facilities are

available. Another possibility was that middle and lower class people are more prone

to stress and strain, which may precipitate the disease Amavata.

Habitat: Majority of the patients (65.78%) in the present study was from urban area.

This may be due to geographical location of the hospital in the urban area.

Family History: 86.84% of the patients of this study reported negative family history

of joint disorders whereas 13.15% patients reported positive family history. But to

give any conclusion regarding the relation of family history with the incidence of

disease Amavata, a large-scale survey of the patients is required.

Education: In the present study maximum no. of patients (73.69%)were educated

from primary to graduate level, while remaining were uneducated (26.31%). It may be

due to urban habitat of the patients.

Addiction: Majority of the patients (53.33%), in the present study did not have any

addiction, tobacco chewing was 33.33% and smoking was 13.33%. All these


146

Discussion

addictions come under Ahitashana and Vishamashana, which lead to Mandagni and

formation of Ama. So, addiction may also play role in the aggravation of the disease

Amavata.

Diet: 73.33% patients in the present study were Vegetarian. This data is only

reflection of predominant diet in this region.

Deha Prakriti: In this study, it was found that maximum number of patients i.e. 50%

were possessing Vatapitta Prakriti (Table no. 12) followed by 30% Vatakapha

prakriti. In general Kapha Prakriti will have Mandagni leading to Ama formation,

which when provoked by Vata and gets settled in respective Sleshma sthana. So, it is

justifiable that Kapha vata prakriti persons are easily prone to Amavata.

Sara & Samhanana: Distribution of patients based on Sara & Samhanana indicates

that maximum no. of patients were of Avara Sara (52.63%) and Madhyama

Samhanana (71.05%).

Satva: Majority of the patients in the present study were possessing Madhyama Satva

(65.78%) and Avara Satva (26.31%), while only 7.89% were of Pravara Satva.

In the Avara and Madhyama Satva persons, stress and strain of daily life may

precipitate or aggravate the disease Amavata.

Satmya: Majority of the patients (63.15%) were of Madhyama Satmya followed by

Pravara Satmya (23.68%) and Avara Satmya (6.88%).

Koshtha: In the present study majority of the patients i.e. 40% had mrudu Koshtha,

which was followed by Madhyama Koshtha in 23.33% of the patients it is followed

by Krura kosta in 20%. In general Vata and Kapha Prakriti persons, have Krura and

Madhyama Koshtha. It justifies the finding of Prakriti, as Prakriti wise distribution of

this study reveals that maximum no. of patients possess Kapha Vata Prakriti.


147

Discussion

Desha: All the the patients i.e. 100% were from Gadag area i.e. Jangala desha due to

the location of the city in Jangala desha.

Chronicity: In the present study, 90% of the patients gave history of chronicity of

more than one year. It may be due to the fact that Amavata is a chronic disease.

Deha Bala: In the present study, majority of the patients (52.63%) were having Avara

Deha Bala, while remaining (47.36%) were having Madhyama Deha Bala. None of

the patient in the present study was having Pravara Deha Bala. It may be due to the

chronic course of the disease, due to which Deha Bala of the patients gradually

declines

Rheumatoid Factor: 33.33% patients, in this study were seropositive . This

observation corroborates very well with textual reference (Davidson – 1994).

Nidana: Majority of the patients in the present study gave the history of 80% of each

Guru and Mandagni and Samyoga virudhasevana (53.33%) Ahara Sevana, and

Prakrivirudha, Samayavirudha ware found of 50%. All these factors leads to

Mandagni and consequently to the formation of Ama. So it can be concluded that all

the above-mentioned factors play an important role in precipitation and aggravation of

the disease Amavata.

Cardinal Features: Regarding the cardinal features of Amavata, all the patients had

Sandhishoola (100%), Sandhishotha [100%), Sandhigraha in 100% and Sandhi

ushnata also in 100%.

General Features: Among the various general features of Amavata, Angamarda and

Aruchi ware found in 80% of patients and other symptoms observed were Gaurava

83.33%, Jwara and Trishna43.33%, Alasya 76.66%, Apaka 56.66%, Nidraviparyaya


148

Discussion

and Kostabadhata in 46.66%, Bahumootrata in 30%, Bhrama in 20% and Chardi in

10%.

Dosha: Maximum number of patients had involvement of Kapha vatavriddhi prakopa

[ie46.66%] followed by Vata vriddhi and prakopa in Amavata [ie 16.66]

Srotasa: Maximum number of patients had the dushti of Asthivaha, Rasavaha,

Majjavaha, Purishavaha, Raktavaha and Annavaha srotasa, which is in accordance

with the main srotasa involved in the disease process

Involvement of Joints: Majority of the patients presented with classical involvement

of Hastasandhi, Padasandhi, Gulphasandhi and Janusandhi.

Rheumatoid Nodules & Deformity: In this study, 2.63% of the patients had

Rheumatoid Nodules and 9 patients had various types of deformity of the joints. It

may be due to chronic nature of the disease.

Effect of the treatment

In this study the effect of treatment was assessed on the basis of changes

observed in different sandhi after the treatment in Sandhisoola, Sandhishotha,

Sandhistabdata and Sandiushnata. The results are discussed parameter wise as here

under:

Effect on Hasta

79.44% relief was observed in Hasta among the patients of Yogabasti group

(group B), 62.78% relief was found among the patients of Nittyavirechana group

(group A).

The improvement was statistically highly significant in both the groups and

comparatively Hasta had better relief in Yogabasti group.


149

Discussion

Effect on Pada

76.78% relief was observed in Pada among the patients of Yogabasti group


(group A).


comparatively Pada had better relief in Yogabasti group.

Effect on Gulpha

59.44% relief was observed in Gulpha among the patients of Yogabasti group


(group A).


comparatively Gulpha had better relief in Yogabasti group.

Effect on Trika

73.33% relief was observed in Trika among the patients of Yogabasti group

(group B), 60% relief was found among the patients of Nittyavirechana group (group

A).


comparatively Trika had better relief in Yogabasti group.

Effect on Janu

70.24% relief was observed in Janu among the patients of Yogabasti group


(group A).


comparatively Janu had better relief in Yogabasti group.


150

Discussion

Effect on Uru

95% relief was observed in Uru among the patients of Yogabasti group (group

B), 60.72% relief was found among the patients of Nittyavirechana group (group A).


comparatively Uru had better relief in Yogabasti group.

Effect on Siro

85.72% relief was observed in Siro among the patients of Yogabasti group


(group A).


comparatively Gulpha had same relief in both groups.

Effect on Hb%

2.21% increment was observed in Hb% among the patients of Yogabasti group

(group B), 3.38% increment was found among the patients of Nittyavirechana group

(group A).


comparatively Hb% had better improvement in Nittyavirechana group.

Effect on ESR

43.59% reduction was observed in ESR among the patients of Yogabasti

group (group B), 51.58% reduction was found among the patients of Nittyavirechana

group (group A).


comparatively ESR had better improvement in Nittyavirechana group.


151

Discussion

Effect on Ama:

Comparison of effects on symptoms of Ama in two groups reveals that, better

improvement was found in patients treated with Yogabasti. The variance of symptom

score before and after the treatment in Yogabasti group was 10.8 and the same in

Nittyavirechana group was 8.9 confirming the better efficacy of the Yogabasti in

relieving the symptoms of Ama. The change observed between the groups was also

statistically significant according to unpaired ‘t’ test.

Effect on clinical parameters

Effect on the range of joint movement:

In an average the range of joint movement was increased by 17.58 degrees in

Yogabasti group as against the increase by 15.29 degrees in Nittyavirechana group.

This implies a better improvement in the range of joint movements in patients treated

with Yogabasti though the statistical analysis by adapting the unpaired ‘t’ test does

not justify the significance of variation between the groups.

Effect on foot pressure:

Comparison of effects of treatments on foot pressure indicates that Yogabasti

group has an edge over the Nittyavirechana in improving the foot pressure after the

treatment. The difference in the mean foot pressure in the Yogabasti group was 9.54

kgs as against 8.25 kgs in Nittyavirechana group. Statistical analysis by unpaired ‘t’

test could not rule out the possibility of chance factor in causing such a variance

between the groups.

Effect on hand grip power:

Yogabasti was found to be more efficacious in improving the hand grip power

in comparison to the Nittyavirechana. After the treatment in Nittyavirechana group

the increase in the mean handgrip power was 24.95 mm of Hg as against 27.25 mm of


152

Discussion

Hg in Yogabasti group. Of course this variation between the groups was statistically

insignificant (P=0.744).

Effect on general functional capacity:

The analysis of the functional disability in both the groups showed that

functional capacity of the patients has increased following the treatment. The

functional disability score reduced to the tune of 0.9 in both the groups, recording no

difference in the efficacy of two treatments when compared.

Over all effect of treatment in both group:

Comparison of the overall effects of the treatment in both the groups reveals

that Yogabasti is more efficacious. Major improvement of the illness was observed in

06(40%) of the patients in Yogabasti group as against 01(6.66%) of the patients in

Nittyavirechana group. 09(60%) of the patients in Yogabasti group recorded moderate

improvement, where as 11(73.33%) patients have show moderate improvement in

Nittyavirechana. 03(20%) of the patients showed minor improvement in

Nittyavirechana.

From the foregoing it is clear that both Yogabasti and Nittyavirechana are very

effective in the patients suffering from Amavata.

Results

The results of the study confirmed that both Nittyavirechana and Yogabasti

have their own role in the management of amavata as the patients belonging to both

groups showed remarkable reduction in the symptoms.

After the treatment when overall assessment was done to assess improvement

between the groups. The Yogabasti group shown 40% Major improvement, where as

Nittyavirechana group shown 6.66% Major improvement, here Major remission has

been considered looking into symptomatic relief of the patient. As the disease is


153

Discussion

yapya or have autoimmune origin, the complete relief from the disease process cannot

be expected. Moderate improvement was observed in 60% of cases in Yogabasti

where as in Nittyavirechana group showed moderate improvement in 73.33%, minor

improvement was seen in 20% of cases of Nittyavirechana group and which is no

found in Yogabasti group. This signifies that Yogabasti possibly had a greater role in

the management of amavata.

At the end of Deepanapachana with vaishwanara churna treatment there was

significant change in that reduction of Ama laxshana was observed in both the groups.

this signifies there is some role of vaishwanara churna to bring down Amavasta in

amavata. But there is no significant difference between the two groups.

From this analysis, it becomes evident that effect of Yogabasti was more

beneficial in Shoola, Shotha, Stabdata and Usnata of different Sandhis, when

compared to that of Nittyavirechana group. But as the disease is yapya or

autoimmune nature the completely permanent remission cannot be expected.

Considering the different incidence and there by generalizing the observations

and results in a population in an incidental study will be inappropriate. More over the

sample size is minimum, ie. 30 patients maintaining the accurate homologocity

between the 2 groups was practically impossible due to difference in various factors

like mode of manifestation of symptoms, chronicity. Influence of dietric factors etc.

from patient to patient. Hence allotment of the patients to different groups could not

and cannot be equal whatever be the care taken to maintain the homologicity.


154

Conclusion

Conclusion

� Disease amavata can be correlated to rheumatoid arthritis, which is one among

the chronic destructive polyarthritis systemic disease.

� The exact etiology of the disease remains unknown, but the pathognomic

nidana like ama is believed to be acts as autoantigen, which triggers the

immunological reaction in genetically susceptible individuals.

� The disease amavata is diagnosed on symptomatology specific laboratory tests

like RF help in diagnostic and ESR help in assessment of treatment given, the

criteria laid down by American Rheumatism Association 1988 which

comprises 7 criteria which helps in the diagnosis of RA.

� Some of the pravruddha amavata laxana and upadravas can be considered as

the extra-articular manifestations of amavata (RA).

� As the disease is genetic and autoimmune in origin the permanent complete

remission is not possible.

� The specific ayurvedic line of management and drugs helps in decreasing the

autoantigens and may acts as modifying the immune response to autoantigens.

At the same time the drugs are safe can be given for longer duration without

any adverse effects.

� Both virechana and basti group have their specific role in the management of

amavata but the clinical study revealed that Yogabasti has a significant role as

higher percentage of reduction in symptoms.

� The active principles of Yogabasti are antagonistic to ama and may acts as

antiinflammatory.


155

Conclusion

Suggestions for Further study.

1. Study on large samples.

2. Study on Nityavirechana followed by basti.

3. Study on langhana, deepana, virechana followed by basti.


156

Summary

Summary

Keeping in mind to evaluate the role of shodhana basti over the virechana in

the treatment of amavata, the study was formulated to evaluate the effect of Yogabasti

over virechana by eranda taila.

The dissertation was made into two parts; the first part contains the

introduction, need for study, historical revive and revive of literature of Virechana,

Basti, Amavata and Drugs. Definition, etymology, history, nidana panchaka,

classification, upadrava, sadhyasadhyata and treatment of amavata according to the

classics and the etiology. pathogenesis, clinical features, diagnostic, differential

diagnosis prognosis, complications and treatment of rheumatoid arthritis. In the

second part the materials and method, observation, results and discussion was made.

In this comparative study 30 patients were incidentally selected and grouped

into A as Nittyavirechana group and B as Yogabasti group. Nittyavirechana group

was treated with vaishwahara churna as deepana pachana and Eranda taila

Nittyavirechana for 8 days. But group B received a course of Yogabasti with

Erandamooladi niruha and Bruhatsandhavadi anuvasana. The duration of the

treatment for both the groups was 24 days. The criteria laid down by ARA (in 1987

& 1967) were applied for the diagnosis and assessment of the treatment.

The observation of the study included the epidemiological features of the

disease. Doshic involvement, the prakruti, agni, kosta and such other factors from the

ayurvedic perspectives.

It was observed that amavata vis-a-vis RA usually appears in between second

and fifth decades of life. The people belong to urban area, females, poor class,

having more susceptible for the disease. The disease is more prevalent in people of


157

Summary

vatapitta and vatakapha prakruti, mandagni, madhyama kosta persons and the

involvement of vata and kapha appear as a prominent feature.

The mean scores of Shoola, Shotha, Stabdata and Ushnata about the joints

before and after the treatment of both the groups were subjected for students‘t’ test

with paired and unpaired methods.

A significant response was obtained in both groups with the percentage

reduction in symptoms. After the treatment, when overall assessment was done to

assess improvement between the groups. The Yogabasti group shown 40% major

improvement where Nittyavirechana group shown only 6.66% major improvement.

Moderate improvement was observed in 90% of cases in Yogabasti where as 73.33%

moderate improvement and 20% minor improvement was seen in Nittyavirechana

group. Change in Hb% and ESR value also observed between two groups, but it

shows the beneficial effect of Nittyavirechana over Yogabasti group.

At the end of treatment there was significant change in shoola, shotha,

stabdata and ushnata in Yogabasti group compared to Nittyavirechana group showing

the P value < 0.001. This signifies that Yogabasti possibly had a greater role in the

management of amavata.


158

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5) Davidson’s Principle and Practice of Medicine. Part 2, 20th chapter. 19th ed, Christopher Haslett, Edwin R, Chilvers, Tohn A, A. Hunter, Nicholas A. Boon editor London ; Churchill livingstone : 2002 P. 1002.

6) I bid.

7) Harrison’s, Principles of Internal Medicine. 6th part, 10th ed. Fouci, Brauwald, Isslbachr, Wilson, Martin, Kasper et al editor. Singapore ; McGraw Hill : 1984. P.1978.

8) Chakrapanidatta, Chakradatta, 25th chapter, 1st Sloka, 3rd ed. Ramanath Dwivedi editor. Varanasi ; Choukhambha Sanskrit Samsthana : 1998. P. 166.

9) Agnivesa, Charakasamhitha Sutrasthana chapter 2. sloka 9. 4th ed.

Varanasi: Chaukhambha Sanskrit Sansthan; 1994. p. 10) Agnivesa, Charakasamhitha Sutrasthana chapter 2. sloka 4. 4th ed.

Varanasi: Chaukhambha Sanskrit Sansthan; 1994. p. 11) Agnivesa, Charakasamhitha Sutrasthana chapter 2. sloka 15. 4th ed.

Varanasi: Chaukhambha Sanskrit Sansthan; 1994. p. 12) Agnivesa, Charakasamhitha Kalpasthana chapter 7-12, 4th ed. Varanasi:

Chaukhambha Sanskrit Sansthan; 1994. . 13) Agnivesa, Charakasamhitha Siddisthana chapter 1. sloka 17-19. 4th ed.

Varanasi: Chaukhambha Sanskrit Sansthan; 1994. p. 14) Agnivesa, Charakasamhitha Siddisthana chapter 2. sloka 11-13. 4th ed.

Varanasi: Chaukhambha Sanskrit Sansthan; 1994. p. 980 15) Agnivesa, Charakasamhitha Siddisthana chapter 6. 4th ed. Varanasi:

Chaukhambha Sanskrit Sansthan; 1994. p.1018-1033 16) Sushrutha, Sushruthasamhitha.Chikitsasthana chapter 33. sloka 1-47.

Varanasi: Krishnadas Academy; 1980. p.520 17) Sushrutha, Sushruthasamhitha.Chikitsasthana chapter 34. sloka 1-22.

Varanasi: Krishnadas Academy; 1980. p.524. 18) Sushrutha, Sushruthasamhitha.Sutrasthana chapter 39. sloka 4. Varanasi:

Krishnadas Academy; 1980. p.170. 19) Sushrutha, Sushruthasamhitha.Sutrasthana chapter 39. sloka 4. Varanasi:

Krishnadas Academy; 1980. p. 170. 20) Ashtangasangraha Suthrasthana chapter 27, Prof.K.R.Shrikhantamurthy,

editor. Varanasi: Chaukhambha Orientalia; 1996. p. 485, 21) Ashtangasangraha Kalpasthana chapter 3 Prof.K.R.Shrikhantamurthy,

editor. Varanasi: Chaukhambha Orientalia; 1996.


159

Bibbilography

22) Vagbhata, Ashtangahridaya Sutrasthana chapter 18. Varanasi: Krishnadas Academy; 1982. p.225.

23) Vagbhata, Ashtangahridaya Kalpasthana chapter 3. Varanasi: Krishnadas Academy; 1982. p.551.

24) Arunadatta, Ashtangahridaya Nidanasthana chapter 13. Varanasi: Krishnadas Academy; 1982.

25) Sharangadhara, Sarngadharasamhitha Utharakhanda chapter 4. 3rd ed. Varanasi: Chaukhambha Orientalia; 1983. p.202.

26) Vrudhajeevaka, Kashyapasamhita Siddhisthana chapter 3 & 4. 4th ed. Varanasi: Chaukhambha Sanskrit Sansthan; 1988. p.274,287.

27) Bhavamishra, Bhavaprakasha Poorvakhanda, Virechanadhikara Edited by Bhishagrashro Bhramhashankara Mishreshastry, 5th edn. Varanasi: Choukambha Sanskrit Sansthan; p. 865.

28) Yogaratnakara, Virechanadhikara, Indradeva Tripathi, 1st edn. Varanasi: Krishnadasa Academy ; 1998.

29) Chakradatta, Chapter 71,Edited by Jagadeeshwar Prasad Tripati, 5th edn. Varanasi : Choukambha Sanskrit Office; 1983, p-610-613.

30) Vidhya Ramagopal Shastri,.Vedon me Ayurveda, Chapter 50. Madan mohanlal editor Varanasi : Vishwabharati Anusandhana Parishadh ; 1956. p. 305, 117.

31) Agnipurana adhyaya sankhya 229. sloka 63. 2nd edi. Acharya Baladeva Upadhyaya, editor. Varanasi Sanskrita University, Varanasi p.335.

32) Agnipurana adhyaya sankhya 289. sloka 46. 2nd edi. Acharya Baladeva Upadhyaya, editor. Varanasi Sanskrita University, Varanasi p.429.

33) Agnivesa, Charakasamhitha Siddisthana chapter 1,5,7,8,10,12. 4th ed. Varanasi: Chaukhambha Sanskrit Sansthan; 1994.

34) Sushrutha, Sushruthasamhitha.Chikitsasthana chapter 35,36,37,38. . Varanasi: Krishnadas Academy; 1980.

35) Vriddha Vagbhata, Ashtangasangraha Suthrasthana chapter 28, Prof.K.R.Shrikhantamurthy, editor. Varanasi: Chaukhambha Orientalia; 1996. p.485.

36) Vagbhata, Ashtangahridaya Suthrasthana chapter 19 Varanasi: Krishnadas Academy; 1982. p.238.

37) Vriddha Vagbhata, Ashtangasangraha Kalpasthana chapter 3, Prof.K.R.Shrikhantamurthy, editor. Varanasi: Chaukhambha Orientalia; 1996.

38) Vagbhata, Astanga Hridaya, Kalpasthana, Chapter 3, Edited by Kaviraj Atridev Gupta, 10th edn. Varanasi : Choukambha Sanskrit Sansthan ; 1992.p.551.

39) Vrudhajeevaka, Kashyapasamhita Siddhisthana chapter 25. sloka 54, 4th ed. Varanasi: Chaukhambha Sanskrit Sansthan; 1988.

40) Bhela.Samhita.Sutrasthana, chapter 6 sloka1. Dr.K.H.Krishnamurthy Chaukhambha vishwabharati Varanasi 2005. p-155.

41) Haritha Samhita chapter 28. sloka 23. Varanasi: Krishnadas Academy; 1980. p. 364.

42) Chakradatta, Chapter 32,Edited by Jagadeeshwar Prasad Tripati, 5th edn. Varanasi : Choukambha Sanskrit Office; 1983, p-283-288.

43) Sharangadhara, Sarngadharasamhitha Utharakhanda chapter 5. 3rd ed. Varanasi: Chaukhambha Orientalia; 1983, p.319.


160

Bibbilography


45) Sharangadhara, Sarngadharasamhitha Utharakhanda chapter 7. 3rd ed.

Varanasi: Chaukhambha Orientalia; 1983. p.336.

46) Bhavamishra, Bhavaprakasha Poorvakhanda, chapter 5, Edited by Bhishagrashro Bhramhashankara Mishreshastry, 5th edn. Varanasi: Choukambha Sanskrit Sansthan, p-865.

47) Mukhopadhyaya Girindranath; History of Indian medicine; 2nd edition,

1974; Oriental Books Represent Corporation, New Delhi.

48) I bid

49) I bid

50) I bid

51) I bid

52) Agnivesa, Charakasamhitha vimanasthana chapter 2. sloka 13. 4th ed. Varanasi: Chaukhambha Sanskrit Sansthan; 1994. p. 566.

53) Agnivesa, Charakasamhitha chikitsasthana chapter 28. sloka 195. 4th ed.

Varanasi: Chaukhambha Sanskrit Sansthan; 1994. p. 808.

54) Agnivesa, Charakasamhitha chikitsasthana chapter 12. sloka 52. 4th ed. Varanasi: Chaukhambha Sanskrit Sansthan; 1994. p. 366.

55) Agnivesa, Charakasamhitha chikitsasthana chapter 16. sloka 61-63. 4th ed.

Varanasi: Chaukhambha Sanskrit Sansthan; 1994. p. 496,497

56) Agnivesa, Charakasamhitha chikitsasthana chapter 15. sloka 75-80. 4th ed. Varanasi: Chaukhambha Sanskrit Sansthan; 1994. p. 464

57) Bhavamishra, Bhavaprakasha madhyakhanda, chapter Amavata chikitsa,

sloka 14-16 Edited by Bhishagrashro Bhramhashankara Mishreshastry, 5th edn. Varanasi : Choukambha Sanskrit Sansthan, p-285.

58) Chakradatta, Chapter 25,sloka 1. Edited by Jagadeeshwar Prasad Tripati,

5th edn. Varanasi : Choukambha Sanskrit Office; 1983.

59) Harita; Harita Samhita; chapter 21, 1985, 1st edition; with Asha Hindi commentary by Ramavalamba Shastri; Prachya Prakashan, Varanasi.

60) Ashtangasangraha chikitsasthana chapter 21 sloka 47,

Prof.K.R.Shrikhantamurthy, editor. Varanasi: Chaukhambha Orientalia; 1996.p.506.

61) I bid


161

Bibbilography

62) Sri Madhvakara, Madhavanidanam, edited by Yadunandana Upadhyaya, chapter 25 – 4th sloka. Chaukhamba Sanskrit Sansthan; 1985 page no. 460.

63) Chakradatta, Chapter 25,sloka 19-20. Edited by Jagadeeshwar Prasad Tripati, 5th edn. Varanasi : Choukambha Sanskrit Office; 1983, p-229.

64) Vangasena, Vangasenasamhitha, Amavatarogadhikara, Jain Sankarlalji Vaidya editor. Mumbai: Khemnath Srikrishnadas publishers; 1996. p 402.

65) Bhavamishra, Bhavaprakasha madhyakhanda, chapter 26, sloka 282 Edited by Bhishagrashro Bhramhashankara Mishreshastry, 5th edn. Varanasi : Choukambha Sanskrit Sansthan, p-277.

66) Yogaratnakara, Virechanadhikara, Indradeva Tripathi, 1st edn. Varanasi: Krishnadasa Academy ; 1998. p 564.

67) Bhaishajyaratnavali, chapter 29, sloka 20. Edited by Ambikadatta Shastry, 15th edn. Varanasi : Choukambha Sanskritha Sansthana ; 2002, p-435.

68) Gheranda samhita 1/49 69) Sterling G. West; Reumatology Secrets;1997, 1st edition; Jaypee Brothers,

New Delhi. 70) Agnivesa, Charakasamhitha Kalpasthana chapter 1, sloka 4 4th ed.

Varanasi: Chaukhambha Sanskrit Sansthan; 1994.p890. 71) Arunadatta, Ashtangahridaya sutrasthana chapter 1 sloka 25. Varanasi:

Krishnadas Academy; 1982. p-13. 72) Agnivesa, Charakasamhitha Kalpasthana chapter 1, 4th ed. Varanasi:

Chaukhambha Sanskrit Sansthan; 1994.p.890. 73) Ashtangasangraha Suthrasthana chapter 27, sloka 5.


74) Ashtangasangraha Chikitsasthana chapter 1, Prof.K.R.Shrikhantamurthy, editor. Varanasi: Chaukhambha Orientalia; 1996.p.173.

75) Agnivesa, Charakasamhitha chikitsasthana chapter 28. sloka 188. 4th ed. Varanasi: Chaukhambha Sanskrit Sansthan; 1994. p.808.

76) Agnivesa, Charakasamhitha Sutrasthana chapter 28. sloka 25. 4th ed. Varanasi: Chaukhambha Sanskrit Sansthan; 1994. p.431.



79) Vagbhata, Ashtangahridaya Suthrasthana chapter 4, sloka 35. Varanasi: Krishnadas Academy; 1982.p.52.

80) Vagbhata, Ashtangahridaya uttrasthana chapter 40. Varanasi: Krishnadas Academy; 1982.p.431.

81) Agnivesa, Charakasamhitha Siddisthana chapter 2, sloka 11-12. 4th ed. Varanasi: Chaukhambha Sanskrit Sansthan; 1994.p.980.

82) Sushrutha, Sushruthasamhitha.Chikitsasthana chapter 33. sloka 28-29. Varanasi: Krishnadas Academy; 1980. p.515.

83) Ashtangasangraha Suthrasthana chapter 25, sloka 9. Prof.K.R.Shrikhantamurthy, editor. Varanasi: Chaukhambha Orientalia; 1996.p.433.

84) Agnivesa, Charakasamhitha Sutrasthana chapter 25. sloka 40. 4th ed. Varanasi: Chaukhambha Sanskrit Sansthan; 1994. p.319,320.

85) Sharangadhara, Sarngadharasamhitha poorvakhanda chapter 4, sloka 3-6 3rd ed. Varanasi: Chaukhambha Orientalia; 1983. p.17.


162

Bibbilography

86) Sushrutha, Sushruthasamhitha.Sutrasthana chapter 44. sloka 1-2. Varanasi: Krishnadas Academy; 1980. p.190.

87) Agnivesa, Charakasamhitha Siddisthana chapter 3, sloka 6. 4th ed. Varanasi: Chaukhambha Sanskrit Sansthan; 1994.p.988.


89) Sushrutha, Sushruthasamhitha.Chikitsasthana chapter 33. sloka 80. Varanasi: Krishnadas Academy; 1980. p.516.

90) Sharangadhara, Sarngadharasamhitha Utharakhanda chapter 3, sloka 14. 3rd ed. Varanasi: Chaukhambha Orientalia; 1983. p-200.

91) Sharangadhara, Sarngadharasamhitha Utharakhanda chapter 3, sloka 15. 3rd ed. Varanasi: Chaukhambha Orientalia; 1983. p-200.





96) Agnivesa, Charakasamhitha Siddisthana chapter 1, sloka 17-20. 4th ed. Varanasi: Chaukhambha Sanskrit Sansthan; 1994.p.664,665.

97) Agnivesa, Charakasamhitha Sutrasthana chapter 16. sloka 5-10. 4th ed. Varanasi: Chaukhambha Sanskrit Sansthan; 1994. p.223,224.



100) Vagbhata, Ashtangahridaya Suthrasthana chapter 18, sloka 38-41. Varanasi: Krishnadas Academy; 1982.p.233.

101) Vagbhata, Ashtangahridaya kalpasthana chapter 3. Varanasi: Krishnadas Academy; 1982.p.551.

102) Sushrutha, Sushruthasamhitha chikitsasthana, “Dalhana” comentry, chapter 33, sloka 8, edited by vaidya jaadavaji trikamji acharya,Varanasi: Chaukhambha Sanskrit Sansthan; 1980.p.516.

103) Agnivesa, Charakasamhitha Siddisthana chapter 6, sloka 28. Varanasi: Chaukhambha Sanskrit Sansthan; 1994.p.1023.


105) Ashtangasangraha Suthrasthana chapter 27, Prof.K.R.Shrikhantamurthy, editor. Varanasi: Chaukhambha Orientalia; 1996.p.460.

106) Agnivesa, Charakasamhitha Sutrasthana chapter 15. sloka 17. 4th ed. Varanasi: Chaukhambha Sanskrit Sansthan; 1994. p.220,221.

107) Agnivesa, Charakasamhitha Siddisthana chapter 1, sloka 12-13. Varanasi: Chaukhambha Sanskrit Sansthan; 1994.p.962.



163

Bibbilography








116) Chakradatta, Chapter 71, sloka 18. Edited by Jagadeeshwar Prasad Tripati, Varanasi : Choukambha Sanskrit Office; 1983, p-612.

117) Yogaratnakara, Virechanadhikara, sloka 1. Indradeva Tripathi, Varanasi: Krishnadasa Academy; 1998. p. 177.

118) Sharangadhara, Sarngadharasamhitha Utharakhanda chapter 4, sloka 20. 3rd ed. Varanasi: Chaukhambha Orientalia; 1983. p.205.



121) Ashtangasangraha Suthrasthana chapter 27, sloka 44-45. Prof.K.R.Shrikhantamurthy, editor. Varanasi: Chaukhambha Orientalia; 1996.p.481.





126) Sharangadhara, Sarngadharasamhitha Utharakhanda chapter 4, sloka 26-33. 3rd ed. Varanasi: Chaukhambha Orientalia; 1983. p.206.

127) Indu, Astanga sangraha sutrasthana, chapter 28, sloka 2. Edited by Dr D. V. Panditarao and Vaidya Ayodhya Pandita, Dellihi, Published by C. C. R. S. Mallik press Dehalli, 1991, p-338.

128) Arunadatta, Ashtangahridaya sutrasthana chapter 19 sloka 1. Varanasi: Krishnadas Academy; 1982, p-231.


130) Adamalla, Sharangadhara, Sarngadharasamhitha Utharakhanda chapter 5, sloka 1.Varanasi: Chaukhambha Orientalia; 1983, p-321.


164

Bibbilography

131) Gudartha deepika, Sharangadhara, Sarngadharasamhitha Utharakhanda chapter 5, sloka 1. 3rd ed. Varanasi: Chaukhambha Orientalia; 1983, p-319.

132) Sushrutha, Sushruthasamhitha chikitsasthana, “Dalhana” comentry, chapter 35, sloka 3-4, edited by vaidya jaadavaji trikamji acharya, Varanasi: Chaukhambha Sanskrit Sansthan; 1980.p.525.

133) Agnivesa, Charakasamhitha Siddisthana chapter 1, sloka 40. Varanasi: Chaukhambha Sanskrit Sansthan; 1994.p.971,972.





138) Agnivesa, Charakasamhitha Siddisthana chapter 1, sloka 40. 4th ed. Varanasi: Chaukhambha Sanskrit Sansthan; 1994.p.971,972.





143) Indu, Astanga sangraha sutrasthana, chapter 19, sloka 85. Edited by Dr D. V. Panditarao and Vaidya Ayodhya Pandita, Dellihi, Published by C. C. R. S. Mallik press Dehalli, 1991, p-226.

144) Agnivesa, Charakasamhitha Siddisthana chapter 1, sloka 38-39. 4th ed. Varanasi: Chaukhambha Sanskrit Sansthan; 1994.

145) Arunadatta, Ashtangahridaya sutrasthana chapter 19, sloka 87. Varanasi: Krishnadas Academy; 1982. p-226.




149) Adamalla, Sharangadhara, Sarngadharasamhitha Utharakhanda chapter 5, sloka 5. 3rd ed. Varanasi: Chaukhambha Orientalia; 1983, p-320.

150) Vrudhajeevaka, Kashyapasamhita Siddhisthana chapter 1, sloka 19.Varanasi: Chaukhambha Sanskrit Sansthan; 1988. p.258.




165

Bibbilography









161) Sharangadhara, Sarngadharasamhitha Utharakhanda chapter 5, sloka 1. Varanasi: Chaukhambha Orientalia; 1983.p.209.




165) Agnivesa, Charakasamhitha Siddisthana chapter 10, sloka 8.Varanasi: Chaukhambha Sanskrit Sansthan; 1994.p.1077.



168) Sharangadhara, Sarngadharasamhitha Utharakhanda chapter 6, sloka 16. Varanasi: Chaukhambha Orientalia; 1983, p-217.






174) Vagbhata, Ashtangahridaya Suthrasthana chapter 19, sloka 63-65. Varanasi: Krishnadas Academy; 1982.p.249,250.


166

Bibbilography

175) Arunadatta, Ashtangahridaya sutrasthana chapter 19, sloka 56-59. Varanasi: Krishnadas Academy; 1982, p-221.




179) Gudartha deepika,Sharangadhara, Sarngadharasamhitha Utharakhanda chapter 5, sloka 4. 3rd ed. Varanasi: Chaukhambha Orientalia; 1983, p-320.

180) Sushrutha, Sushruthasamhitha chikitsasthana, “Dalhana” comentry, chapter 38, sloka 100-101, edited by vaidya jaadavaji trikamji acharya,Varanasi: Chaukhambha Sanskrit Sansthan; 1980.p.547.

181) Sushrutha, Sushruthasamhitha chikitsasthana, “Dalhana” comentry, chapter 38, sloka 102, fourth edition ; edited by vaidya jaadavaji trikamji acharya,Varanasi: Chaukhambha Sanskrit Sansthan; 1980.p.547.

182) Sushrutha, Sushruthasamhitha chikitsasthana, “Dalhana” comentry, chapter 38, sloka 103, fourth edition edited by vaidya jaadavaji trikamji acharya,Varanasi: Chaukhambha Sanskrit Sansthan; 1980.p.547.

183) Sushrutha, Sushruthasamhitha chikitsasthana, “Dalhana” comentry, chapter 38, sloka 104-105,edited by vaidya jaadavaji trikamji acharya,Varanasi: Chaukhambha Sanskrit Sansthan; 1980.p.547.

184) Sushrutha, Sushruthasamhitha chikitsasthana, “Dalhana” comentry, chapter 38, sloka 106-111, edited by vaidya jaadavaji trikamji acharya,Varanasi: Chaukhambha Sanskrit Sansthan; 1980.p.548.

185) Agnivesa, Charakasamhitha Siddisthana chapter 8.Varanasi: Chaukhambha Sanskrit Sansthan; 1994.p.1043.

186) Sushrutha, Sushruthasamhitha.chikitsasthana chapter 35. sloka 6. Varanasi: Krishnadas Academy; 1980. P.525.

187) Sushrutha, Sushruthasamhitha.nidanasthana chapter 35. sloka 18. Varanasi: Krishnadas Academy; 1980. p.526.

188) Sushrutha, Sushruthasamhitha.nidanasthana chapter 35. sloka 18. Varanasi: Krishnadas Academy; 1980. p.526.


190) Sushrutha, Sushruthasamhitha.chikitsasthana chapter 35. sloka 18. Varanasi: Krishnadas Academy; 1980. p.460.

191) Sri Madhvakara, Madhavanidanam, edited by Yadunandana Upadhyaya, chapter 25, 2 - 4th sloka. Chaukhamba Sanskrit Sansthan; 1985 page no. 460.

192) Sri Madhvakara, Madhavanidanam, edited by Yadunandana Upadhyaya, chapter 25, 2 - 5th sloka. Chaukhamba Sanskrit Sansthan; 1985 page no. 461.

193) Rajaradha Kantadeva Bahudarena, Shabdha kalpadruma, 3 rd edn. Varanasi : Choukambha Sanskrit Series office ; 1967. p 183.

194) Sri Madhvakara, Madhavanidanam, edited by Yadunandana Upadhyaya, chapter 25, 6th sloka. Chaukhamba Sanskrit Sansthan; 1985 page no. 461.


167

Bibbilography

195) Rajaradha Kantadeva Bahudarena, Shabdha kalpadruma, 3 rd edn. Varanasi : Choukambha Sanskrit Series office ; 1967. p 183.

196) Amarasimha, Amarakosha Manushyavarga Pundit Vishwanath Jha, editor. Delhi: Motilal Banarasi Das; 1976.

197) Ashtangasangraha Suthrasthana chapter 21, sloka 36. Prof.K.R.Shrikhantamurthy, editor. Varanasi: Chaukhambha Orientalia; 1996.


199) Sri Madhvakara, Madhavanidanam, edited by Yadunandana Upadhyaya, chapter 25, 1 - 5th sloka. Chaukhamba Sanskrit Sansthan; 1985 page no. 460,461.


201) Sushrutha, Sushruthasamhitha sutrasthana, “Dalhana” comentry, chapter 21, sloka 5, edited by vaidya jaadavaji trikamji acharya,Varanasi: Chaukhambha Sanskrit Sansthan; 1980.p102.


203) Ashtangasangraha Suthrasthana chapter 1, sloka 26. Prof.K.R.Shrikhantamurthy, editor. Varanasi: Chaukhambha Orientalia; 1996, p-7.

204) Ashtangasangraha Suthrasthana chapter 19, sloka 1. Prof.K.R.Shrikhantamurthy, editor. Varanasi: Chaukhambha Orientalia; 1996, p-.


206) Sharangadhara, Sarngadharasamhitha Utharakhanda chapter 5, sloka. 3rd ed. Varanasi: Chaukhambha Orientalia; 1983.

207) Agnivesa, Charakasamhitha chikitsasthana chapter 28, sloka 4. Varanasi: Chaukhambha Sanskrit Sansthan; 1994.p.775.

208) Sri Madhvakara, Madhavanidanam, edited by Yadunandana Upadhyaya, chapter 25, 1st sloka. Chaukhamba Sanskrit Sansthan; 1985 page no. 460.

209) Haritha Samhita Varanasi: Krishnadas Academy; 1980, p- 201. 210) Anjana nidana, Agnivesha edited by Ramchandra Shastri

Kinjavadekara, Chitrashala Mudranalaya, Pune (1940). 211) Ashtangasangraha Suthrasthana chapter 9, sloka 7.


212) Agnivesa, Charakasamhitha Sutrasthana chapter 26. sloka 86-87. 4th ed. Varanasi: Chaukhambha Sanskrit Sansthan; 1994. p.362.



215) Agnivesa, Charakasamhitha chikitsasthana chapter 28, sloka 19. 4th ed. Varanasi: Chaukhambha Sanskrit Sansthan; 1994.p.780.


168

Bibbilography


217) I bid sloka 6-10.p.462. 218) I bid sloka 7-10.p.461, 462. 219) Agnivesa, Charakasamhitha chikitsasthana chapter 20, sloka 20. 4th

ed. Varanasi: Chaukhambha Sanskrit Sansthan; 1994.p.581. 220) Sushrutha, Sushruthasamhitha.uttarasthana chapter 46. sloka 6.

Varanasi: Krishnadas Academy; 1980. p.739. 221) Sushrutha, Sushruthasamhitha sutrasthana, “Dalhana” comentry, chapter 15,

sloka 4, edited by vaidya jaadavaji trikamji acharya,Varanasi: Chaukhambha Sanskrit Sansthan; 1980.p.67.


223) Agnivesa, Charakasamhitha Sutrasthana chapter 18. 4th ed. Varanasi: Chaukhambha Sanskrit Sansthan; 1994. p.249.

224) Sushrutha, Sushruthasamhitha sutrasthana, “Dalhana” comentry, chapter 15, sloka 24, fourth edition ; edited by vaidya jaadavaji trikamji acharya,Varanasi: Chaukhambha Sanskrit Sansthan; 1980.p.72.


226) I bid sloka 6-10.p.461,462. 227) Bhavamishra,Bhavaprakasha Nighantu. Chapter 26, sloka 282-290

Edited by G.S. Pande. , 6th edn. Varanasi : Choukambha Bharati Academy ; 1982.

228) Bhaishajyaratnavali, chapter 29, sloka 20-25.Edited by Ambikadatta Shastry, 15th edn. Varanasi : Choukambha Sanskritha Sansthana ; 2002, p-435.

229) Yogaratnakara, Indradeva Tripathi, 1st edn. Varanasi: Krishnadasa Academy ; 1998.P 564-566.

230) Gadanigaha: chapter 22, sloka 6-12 Sodhal with Vidyotini Hindi commentary by I.D. Tripathi, editor Ganga Sahaya Pandey, ed. 3, Chaukhambha Sanskrit Bhavan (1999), p-544.


232) I bid sloka 12.p.464. 233) I bid sloka 6.p.462. 234) I bid sloka 7-10.p.463. 235) Haritha Samhita Varanasi: Krishnadas Academy; 1980. 236) Sri Madhvakara, Madhavanidanam, edited by Yadunandana

Upadhyaya, chapter 25, 10st sloka. Chaukhamba Sanskrit Sansthan; 1985 page no. 462.

237) Vagbhata, Ashtangahridaya nidanasthana chapter 1, sloka 6-7. Varanasi: Krishnadas Academy; 1982.p.463.



169

Bibbilography

239) Chakradatta, chapter 25, sloka 19-20. Edited by Jagadeeshwar Prasad Tripati, 5th edn. Varanasi : Choukambha Sanskrit Office; 1983, p-229.

240) Bhavamishra, Bhavaprakasha, Edited by Bhishagrashro Bhramhashankara Mishreshastry, 5th edn. Varanasi : Choukambha Sanskrit Sansthan ;

241) Bhaishajyaratnavali, Edited by Ambikadatta Shastry, 15th edn. Varanasi : Choukambha Sanskritha Sansthana ; 2002, p-435.

242) Agnivesa, Charakasamhitha Sutrasthana chapter 22. . 4th ed. Varanasi: Chaukhambha Sanskrit Sansthan; 1994. p.288.

243) I bid 244) Sushrutha, Sushruthasamhitha.chikitsasthana chapter 32. sloka 21.

Varanasi: Krishnadas Academy; 1980. p.514. 245) Sharangadhara, Sarngadharasamhitha poorvakhanda chapter 4, sloka

1.Varanasi: Chaukhambha Orientalia; 1983.p.17. 246) I bid 247) Ashtangasangraha Suthrasthana chapter 27, sloka 30.

Prof.K.R.Shrikhantamurthy, editor. Varanasi: Chaukhambha Orientalia; 1996, p-476.

248) Bhavamishra, Bhavaprakasha, chapter 25. Edited by Bhishagrashro Bhramhashankara Mishreshastry, 5th edn. Varanasi: Choukambha Sanskrit Sansthan ;

249) Bhaishajyaratnavali, Amavatadhikara. Edited by Ambikadatta Shastry, 15th edn. Varanasi : Choukambha Sanskritha Sansthana ; 2002, p-435.

250) Text book of Rheumatology, by Kelly et al, 5th edition, Published by W. B. Saunders company, Philadelphia, Pensylvania. P 1225.

251) Challenge in RA by Haward A. Bird et al, 1st edition 1999, published by Blackwell science limited Paris, France. P 7-8.

252) API text book of medicine, Edited by G. S. Sainani, 6th edn. Mumbai : Association of Physicians of India ; 1999. p 1028.

253) Arthritis and Ayurveda by Dr. K. Nishteshwara. P 3. 254) Robins pathologic basis of disease by Cotron et al, published by

Harwart pvt limited. Lajpat nagar, N. Delhi. P 140-142. 255) Henry N, Ginsburg, Ira J. Goldburg, Harrison’s Principles of

International Medicine, 14th edn. New York. : Mc Graw Hill Companies 1998. p 1933.

256) Text book of Rheumatology, by Kelly et al, 5th edition, Published by W. B. Saunders company, Philadelphia, Pensylvania. P 1225-1230.


258) API text book of medicine, Edited by G. S. Sainani, 6th edn. Mumbai: Association of Physicians of India; 1999. p 1028.

259) Robins pathologic basis of disease by Cotron et al, published by Harwart pvt limited. Lajpat nagar, N. Delhi. P 1405.

260) Henry N, Ginsburg, Ira J. Goldburg, Harrison’s Principles of International Medicine, 14th edn. New York. : Mc Graw Hill Companies 1998. p 1929-30.




170

Bibbilography


264) Challenge in RA by Haward A. Bird et al, 1st edition 1999, published by Blackwell science limited Paris, France. P 98-106 & 114.

265) API text book of medicine, Edited by G. S. Sainani, 6th edn. Mumbai : Association of Physicians of India ; 1999. p 1028.

266) Robins pathologic basis of disease by Cotron et al, published by Harwart pvt limited. Lajpat nagar, N. Delhi. P 140-142.




270) Bhavamishra, Bhavaprakasha, chapter 26, sloka 50. Edited by Bhishagrashro Bhramhashankara Mishreshastry, 5th edn. Varanasi : Choukambha Sanskrit Sansthan

271) Yogaratnakara, Indradeva Tripathi, 1st edn. Varanasi: Krishnadasa Academy ; 1998. Sloka 1, p 107.

272) Yogaratnakara, Indradeva Tripathi, 1st edn. Varanasi: Krishnadasa Academy ; 1998.Sloka 1, p 107.


274) Sushrutha, Sushruthasamhitha.chikitsasthana chapter 31. sloka 5. Varanasi: Krishnadas Academy; 1980. p-508.

275) Chakradatta, chapter 25, sloka 45-48. Edited by Jagadeeshwar Prasad Tripati, 5th edn. Varanasi: Choukambha Sanskrit Office; 1983, p-231.

276) Ashtangasangraha kalpasthana chapter 4, sloka 5. Prof.K.R.Shrikhantamurthy, editor. Varanasi: Chaukhambha Orientalia; 1996, p-440.


171

SPECIAL CASE SHEET FOR “AMAVATA”[RA] Post Graduate Studies and Research Centre (Panchakarma)

Shri. D.G.M.Ayurvedic Medical College, Gadag.

Guide : Dr. G. Purushottamacharyalu M.D (Ayu), M.A (Asto) Co-Giide : Dr. Shashidhar H Doddamani M.D (Ayu) Scholar : Suresh N. Hakkandi 1. Name of the patient : Sl. No.

2. Father’s/Husband’s Name : OPD No.

3. Age : ………... yrs IPD No.

4. Sex : Male/Female Bed No.

5. Religion :

Hindu Muslim Christian Others 6. Occupation :

Sedentary Active Labor Others 7. Economical Status :

Poor Middle Upper middle Higher 8. Diet :

Veg Mixed 9. Address : …………………………. Phone No. …………………………. E- Mail: …………………………. Pin code:

10. Date of Schedule of Initiation:

11. Date of Schedule of Completion:

12. Result :

Completely Relieved

Good Response

Moderate Response

Poor Response

No Response

13. Consent : I here by agree that, I have been fully educated with the disease and treatment. Here by satisfied whole-heartedly, and accept the medical trial over me.

Investigator’s Signature. Patient’s Signature

1

Pradhana vedana

1) Local features of joints:

Sl.No Different joints Ruja Shotha Sthbdata Ushnata

BT AT BT AT BT AT BT AT

1. Hasta

2 Pada

3 Gulpha

4 Trika

5 Janu

6 Uru

7 Sira

2) Associated complaints : Sl.No B/T A/T A/T/F

1 Jwara

2 Angamarda

3 Aruchi

4 Apaka

5 Trushna

6 Alasya

7 Bahumoolrata

8 Hrullasa

9 Gourava

10 Agnimandya

11 Lalasrava

12 Nidra viparyaya

13 Chardi

14 Bhrama

15 Murcha

16 Hrudgraha

17 Kosta baddata

18 Anga shunyata

2

II) History of Patient Illness : Mode of onset

Insidious Acute Systemic Palindrome

Oligo articular Poly articular Mono articular

Symmetrical Asymmetrical Sequence of joins involved 1)__ 2) __ 3) __ 4) __5)__ 6)__7)___ Nature of disease

Progressive Regressive Constant Intermittent Routine actives affected

Mild Moderate Severe Not affected III) History of the Past Illness: IV) Previous treatment History: V) Family History: VI) Personal History: 1) Ahara Taste Predominance

Vegetarian Mixed food

Sweet Sour Salt Pungent Bitter Astringent

2) Jatharagni Manda Teekshna Vishama Sama 3) Pureesha Pravritti :

vibandha Dravavit Prakrita Frequency

4) Mutra Pravritti : Frequency Day Night Mutra Daha 5) Nidra Sukha Alpa Ati Vishamya 6) Vyasana

Smoking Alcohol Tobacco No Habits

3

7) Artava Pravritti Days Samanya Alpa Adika Rajonivritti

VII) Examination of Patient ( Vital)

1) Pulse 2) Blood Presser 3)

Temperature / Min 0F mm Hg

4) Height 5) Respiration 6) Weight / Min /Min Kg

VIII a) Special Examination (Ayurveda)

1. Nadi V P K VP VK PK VPK 2. Prakruti V P K VP Vk PK VPK 3. Sara Pravara Avara Madhayama 4. Samhanana Susamhita Asamhita Madhyma Samhita 5. Pramana Height in Cms Weight in Kgs 6. Satmya Ekarasa Sarvarasa Ruksha Sneha 7. Satwa Pravara Avara Madhyama 8. Ahara Shakti Abhyavaharna Jarana 9. Vyayam Shakti Pravara Avara Madhayam 10. Vaya Balya Yauvana Vardhakya 11. Desham (Deha) Bhumi Jangala Anupa Sadharana Nidana

Aahara Vihara Others Guru bhojana Virudha Chesta Mandagni Virudha Bhojana Prakruti Virudha Avyayama Samaya Virudha Vyayama after snigdha

bhojana

Samyoga Virudha Ativyayama Samprapti Ghatakas Dosha Dushya Adhistana Srotas Roga Marga Udbhaavasthana Sancharasthana Vyaktasthana Adhistana Srotodusti

4

VIII b) Special Examination (Joints)

Sakha Pareekshaa Scores Before After After FollowupDeformity of joints Swelling Rhumatic nodules

Dar

shan

a

Muscle wasting Skin over the joint Warmth over joint Tenderness

Intra articular

Swelling

Extra (peri) articular

Bursitis Tenosynovitis Synovial thickening

Spar

shan

a

Bony Components Palpable

Shravana (Crepitation)

VIII c) Special Examination (Extra articular manifestation)

Extra articular manifestation Before After After Follow Up Low Grade Fever Loss of appetite Loss of Weight Fatigue Muscle Wasting Anemia Sicca Syndrome

VIII d) Assessment of Investigations

Sl.No Name of the Test Baseline Values Final Values 1 ESR mm of 1st hour mm of 1st hour 2 Hb% mg% mg% 3 CRP 4 ASO Titer 5 RA IX) Upsaya / Anupasaya : 1) Ruksha sweda – Pain Reduced :Yes / No 2) Snigdha sweda – Pain increased : Yes / No X) Types of Amavata :

Doshanubandha Kalanubandha

Vataja Pittaja Kaphaja Naveena Pravrudha Jeerna

5

XI) Treatment Protocol: For Group-A Patients: Nitya Virechana

Poorva Karma Amapachana

Drug Used Vaishawanara Choorna No. Days Pradhana Karma Eranda Taila Nitya Virechana

Quantity used

Time of Administration

No. of Vegas

1st day 2nd day 3rd day 4th day 5th day 6th day 7th day 8th day

Paschat Karma :

For group – B Patients : Yoga Basti Poorva Karma

Amapachana

Drug Used Vaishawanara Choorna No. Days Pradhana Karma Sl.No Particulars AB NB AB NB AB NB AB AB 1 Dravya 2 Pramana 3 Date 4 Time 5 Pratyagamana Kala 6 Annya Vasti Vyapat 7 Miscelaneous

Paschat Karma Signature of Co-Guide Signature of Guide

Dr. S.H.Dodmani Dr. G. Purshottamacharyulu

M. D (Ayu) M. D.(Ayu)

6

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