Cause and Pathogenesis of Amavata
Vata is responsible for all the sensory and motor activities of the body. With advancing age or other precipitating factors Vata gets aggravated causing degenerative changes in joints and body, leading to dryness, pain, swelling and difficulty in movement. Aggravation of Vata dosha and accumulation of A m a (Metabolic toxin) is the main cause of Rheumatoid Arthritis. Kapha dosha and Pitta dosha are also invariably involved in the pathogenesis. Due to improper functioning of Agni (Metabolic fire), there is malfunctioning of digestive and metabolic systems leading to Ama formation. Vitiated Vata dosha circulates the Ama in the whole body and gets deposited at the sites which are weaker. When it deposit in the joints it leads to manifestation of the symptoms of the disease such as pain, stiffness, swelling, tenderness in small and big joints, fever and weakness. Involvement of joints restricts the normal body movements which may lead to contracture of muscle and permanent deformities making a person lame. This disease is called Amavata (Rheumatoid Arthritis). The symptoms of Amavata are identical to rheumatism, which include rheumatoid arthritis and rheumatic fever.
Line of treatment
In the management of Amavata all the Acharyas (Ancient Physicians) have described the sequential employment of Langhana, Snehana, Swedana, Virechana, Basti and Shaman therapies.
1. Langhana (Light and easy to digest food): This is first line of treatment. Using easy and light to digest foods such as vegetable or lentil soups added with Dipana (Appetizers) and Amapachana (Digestives) herbs and spices like ginger, pepper, etc to correct the functions of Agni (Digestive & Metabolic fire). Freshly prepared warm and easy to digest food in liquid or semisolid form is advised for a prescribed period of time.
2. Swedana (Fomentation): Dry fomentation using sand or salt is recommended. Upanaha (local medicinal application) can also be done to relieve pain.
3. Snehana (Internal and External Oleation): Suitable medicated ghee / oils are used for internal and external oleation.
4. Virechana (Purgatives): After oleation and fomentation, Purgation with suitable herbs yields best results.
5. Basti (Medicated enema): Various medicated enemas with suitable herbs are beneficial.
6. Shamana Chikitsa : Suitable Ayurvedic herbal formulations are administered. Ayurveda utilizes immunomodulatory and Rasayana herbs which help in correcting the Agni (Digestive and Metabolic fire), eliminating Ama (Amapachana) and pacifying Vata dosha for treating Amavata.
Advise on Diet and Lifestyle
1. Foods which are homemade, freshly prepared and warm, easily digestible, vegetable juices, vegetable and lentil soups, cooking with spices like cumin, coriander, ginger, asafetida, fennel and turmeric is beneficial.
2. Restriction of hot, spicy and fried foods, sweets, Vata aggravating (Wind forming) foods like cabbage, cauliflower, broccoli, lady’s finger and potatoes is necessary.
3. Excessive intake of tea, coffee, fast food, processed food, food additives, non vegetarian food, white sugar, chocolate and cocoa, refrigerated food and drinks, sour curd / yogurt, sour food items like tamarind should be avoided.
4. Excessive alcohol, smoking, sleeping during day time, staying up late in the night and mental tensions like worry, anxiety, fear, stress and grief etc., should be given up.
5. Regular physical exercise and every day gentle massage with oil should form an important part of life style.
6. One should avoid exposure to cold breeze and excessive wind.
7. Bathing with cold water should be avoided. Warm water bath is recommended.
8. It is also advisable to take a gentle walk after every meal.
9. Light exercise is beneficial.
An analysis of a Rheumatoid Arthritis case at Chakrapani Ayurveda Center:
Presentation / History: The patient, a thirty-eight year old female presented with a diagnosis of rheumatoid arthritis from her rheumatologist twelve years prior to being seen at our hospital. She complained of joint pains and stiffness throughout her body, most severely in her hands, wrists and sacroiliac joint. In addition to the joint and muscle discomforts the patient complained of significant fatigue and difficulty in walking. Movements of upper arm were restricted. She had constipation. There was ulnar drift and swan neck deformity. She was under oral Corticosteroids and Immunosuppressant for more than 10 years.
Examination: The patient had obvious signs of discomfort including inflammation in her wrists, fingers, elbows and other joints causing her to move with discomfort. The joints were stiff and slightly swollen. The patient was significantly underweight at five feet one inch tall and 49.5 kg. The blood pressure was normal. The erythrocyte sedimentation rate was elevated at 48 mm per hour and RA factor was positive.
Treatment protocol: Customized Panchakarma therapies were administered for 21 days to help ease the patient’s discomforts and to encourage healing.
Panchakarma Treatments : Yoga Basti (Therapeutic medicated enema for 8 days), Virechana (Purgation) and Nasya (Nasal medication) were the main Panchakarma (Detoxification) therapies administered. Other treatment procedures like Marma Abhyanga (Therapeutic gentle body massage), Swedana (Steam bath), Dhanyamladhara, Katibasti, Greevabasti, Valuka swedana, Upanaha, Pinda swedana, Pizhichil were administered.
Yoga Basti Therapy – The patient was given 5 Anuvasana basti and 3 Niruha basti.
Virechana Therapy – The patient had Krura Koshta (Hard bowels) and Pravara Satva (Good mental tolerance). She was administered 6 days of Snehapana (Drinking of medicated ghee) in increasing dose followed by Virechana (Purgation). On administration of Virechana, she had 35 bowel movements and suitable Samsarjana karma (Post Panchakarma diet) was given.
Diet and lifestyle during Panchakarma – The patient was placed on a bland diet, lentil soup and cooked vegetables. Rest and proper sleep were advised.
Internal Medicines – Shallaki capsule, Sunthi guggulu, Sinhanada guggulu and customized herbal compound powder consisting of Guduchi, Gokshura, Ashwagandha, Pippalimool, Shatavari and Godanti were given.
Observation – At the end of Panchakarma the patient’s condition began to improve, her swelling and pain was reduced and the flexibility of joints improved. Favorable results were obtained with the help of Panchakarma and with her positive attitude and compliance with the treatment program.
On discharge, the patient was counselled and advised on the need to follow the healthy and suitable diet and lifestyle. She was made to understand that a return to former habits or excessive levels of stress is likely to cause a resumption of disease activity and need to be disciplined in taking proper care of herself on an ongoing basis. Her health condition was reviewed at periodic intervals.