Rheumatoid Arthritis (Amavata)

Background

Rheumatoid Arthritis (Amavata) is an autoimmune inflammatory disease that causes pain, swelling, stiffness, destruction and functional disability in the affected joints. It is defined as a chronic multisystem disease characterized by persistent inflammatory synovitis, usually involving peripheral joints in a symmetric distribution with a potential to cause cartilage destruction and bone erosions. Rheumatoid Arthritis affects all races throughout the world and it is 3 times more common in women than men. Generally, it occurs during the fourth and fifth decades of life but people of any age can be affected.

According to Ayurveda, the main cause of the disease is formation of Ama due to Agnimandya. The general principles of treatment of this disease in Ayurveda lay emphasis on stimulating and normalizing the impaired Agni by the use of Langhana, Deepana, Pachana, and Katu, Tikta Rasa predominant drugs (for the correction of digestion and metabolism). For detoxification Swedana (sudation), Virechana (therapeutic purgation) and Vasti (therapeutic enema) are recommended.

Intervention/ Approaches

The following are some interventions/ approaches based on CCRAS research from published sources.

In case of chronic Amavata patients, who are not responding to conservative medicines:

Deepana Pachana

• Vettumaran Gutika 1 tablet thrice a day for 14 days
• Bala Guduchyadi Kwatha 40ml thrice a day for 14 days.

Snehana - Indukanta Ghrita for 7 days (till attaining Samyak Snehana).
Swedana - Vashpa Sweda for 3 days.
Vamana Karma by using Vamana Yoga

• Madana Phala (Randia dumetorum) -1 Ogm
• Pippali Chuma {Piper longum ) -5gm
• SaindhavaLavan-2.5gm
• Honey-20gm
• Milk-3Litres.

Samsarjana Karma -beginning with liquid diet, gradually change to
normal diet.

In case of acute condition of Amavata associated with pain and inflammation:

• Shunthi Guggulu [Shunthi (Zinziber officinale) and Guggulu (Commiphora wightii) in equal parts] - 2gm thrice a day with warm water.
  External application - Dashanga Lepa and Baluka Sweda.
• Shunthi Guggulu - 4gm thrice a day with warm water for 6 weeks. Baluka Sweda for 6 weeks.

In case of chronic Amavata associated with pain, inflammation and gastro-intestinal disturbances:

• Mahayogaraja Guggulu -1 gm thrice a day.
• Vaishwanara Chuma - 3 gm twice in a day after meal.
• Simhanada Guggulu - 500mg at bed time.

In case of early stage of Amavata associated with pain, inflammation and gastro-intestinal disturbances:

• Ashwagandha Chuma - 3gm thrice a day with water for 6 weeks.
• Eranda Taila -15ml at bed times for 6 weeks.
• Baluka Sweda daily for 6 weeks.

In case of chronic Amavata associated with pain, inflammation, stiffness and degenerative changes in joints:

Shallaki (Boswellia serrata) 1 part + Suranjana (Colchicum luteum) 1 part - 500mg thrice a day with warm water for 6 weeks.

In case of acute condition of Amavata associated with severe pain and inflammation:

Rasonadi Kwatha - 25ml thrice a day for 6 weeks

Ingredients of Rasonadi Kwatha

• Shunthi {Zinziber officinale) -25gm
• Rasona (Alium sativum) -25gm
• Nirgundi (Vitex negundo)-25gm

During acute inflammation

Dashanga Lepa and Baluka Sweda for external application.

During pain

Pippalimula Chuma 3gm and Vishtinduka Vati 500mg.

In chronic condition of Amavata associated with stiffness and joint deformity:

• Yogaraj Guggulu -1 gm thrice a day for 6-8 weeks.
  Vatagajankusha Rasa - 250mg thrice a day for 6-8 weeks..
  Maharasnadi Kwatha - 50ml thrice a day for 6-8 weeks.
• Shunthi Guduchi Kwatha - 50ml thrice a day for 6-8 weeks.

In chronic condition of Amavata associated with pain, gastrointestinal disturbances and joint erosion / osteoporosis:

Shxmthi(Zinziber officinale) + Gugguhi(Commiphera wightii) + Godanti(Gypsum) Bhasma (in the proportion of 1:2:1) - 2gm thrice a day with honey for 6 weeks.

In chronic condition with pain, stiffness, gastrointestinal disturbances and j oint deformity, when other treatment is not responding:

Pippali Vardhamana Ksheera Paka - on empty stomach in the morning for 6 weeks (Start with one crushed Pippali for Ksheera Paka on first day and add one more Pippali every day up to 4 days thereafter reduce one pippali every day upto next 3 days.Same procedures may be followed for remaining 5 weeks).

Sameera Pannaga Rasa - 250mg thrice a day with honey for 6 weeks.
Snehana - Indukanta Ghrita for 7 days (till attaining Samyak Snehana).
Swedana - Vashpa Sweda for 3 days.
Vamana Karma one day using Vamana Yoga containing

• Madanaphala (Randia dumetorum) -1 Ogm
• Pippali Chuma (Piper longum) -5gm
• SaindhavaLavana-2.5gm
• Honey-20gm
• Milk-3Litres.

Samsaijana Karma -beginning with liquid diet gradually change to normal diet.

In case of severe pain in joints:

Nirgundi patra + Panchkola Chuma prakshepa Pinda Sweda for 6 weeks.

Medicinal Plants useful in Rheumatoid Arthritis (Amavata)

Source : Central Council for Research in Ayurvedic Sciences