HTML Full Text

Introduction

In today’s modern era due to change in modern life style, unhealthy eating habits, hectic schedule and stress,lack of  exercise, accumulation of mala  and condition of mental stress like shok, bhay, chinta are the responsible factor for  Mandagni which forword leads to production of Ama in the body. The Ama is carried by the aggravated Vata and gets deposited in Sleshmasthanas (Seats of kapha like asthi, sandhi and Aamashay) producing features like Prabhate graha, Sandhiruja (joint pain), Sandhishotha (joint swelling), Angamarda (bodyache), Agnimandya (loss of digestive fire), etc. The clinical features of Aamvata very closely resembles with the Rheumatoid arthritis. Ama related incidence increases and Aamvata is common desease nowadays.In ayurved literature madhavkar first mentioned Aamvat as a separate disease. Aamvata has two components Aam and vata which contribute mainly in disease. The main factor Aam is produced due to malfunctioning of the digestive and metabolic mechanism.

Material and Method: Place of Study–IPD Of Kaychikitsa,L.K Ayurved Hospital Yavatmal.

Case Report: A 54-year female patient came to Kaychikitsa OPD with following complaints of -

1. Prabhate graha (Morning stiffness)
2. Manibandhsandhi shool (Wrist joint pain),
3. Kurparsandhishool (Elbow joint),
4. Hastanguliparva sandhi shool (Interphalges of both hands),
5. Paadanguliparva sandhi shool,
6. Janusandhi (knee joints)
7. Aruchi (Malaise),
8. Agnimandya(loss of digestive fire)

Above all complaints resembles with Aamvata³

History of past Illness – k/C/O HTN for 5 years (on medication)

No/H/O-DM/Thyroid/Asthma.

History of present illness – Patient was healthy 6 months ago but since last 6 months patient had above complaints for which she had taken allopathic medicine like painkillers, steroids,etc with this drugs she gets temporary and symptomatic relief but later on this drugs produces adverse effects. So she came to Kaychikitsa OPD of L.K.Ayurved Hospital, Yavatmal.

PERSONAL HISTORY  : Addiction -No any.

Family History -No family history related to disease

RUGNAPARIKSHAN

Nadi-84/Min

Mal-Samyak

Mutra-Samyak

Jivha-Alpasam

Shabd-Spasht

Sparsh-Samshitoshn

Netra-Pitabh shwet

Aakruti -Madhyam

Prakruti-Kaphanubandhi vataj

Nidra-Anidra

LABORATORY EXAMINATION

Hb-12.3 gm%

TLC-7240/cmm

PLATELET –3,39000

RA-Positive (Titre: -256)

CRP-Positive (Titre: -9.6)

ESR-50 mm/hr

SAMPRAPTI GHATAK

Dosha -Tridosha, mainly Vata (Vyana, Samana, Apana) and Kapha (Kledaka, Bodhaka, Sleshmaka).

Dhatu -Rasa, Mansa, Asthi, Majja

Updathu -Snayu, Kandara.

Srotas - Annavaha, Rasavaha, Asthivaha, Majjavaha

Srotodushti - Sanga and Vimarg gaman

Udbhava sthana - Amashaya-chiefly production of Ama, Pakvashaya-Mula Sthana of Vata

Adhisthana - Whole body (mainly Sandhi and Asthi)
Vyakiti Sthana - Whole body (Sandhi)

Roga Marga - Madhyama Roga Marga

Avayava - Sandhi

Vyadhi Svabhava - Mainly Chirakari

SHATKRIYAKAL IN AAMVATA?

Sanchaya and Prakopa: When exposed to etiological factors like Viruddha aahar, vyayama is performed after taking snigdha ahara, chinta, krodha etc. agnimandya leads from Sanchaya and Prakopavastha to tridoshadushti and amotpatti.

Prasara: With the help of Vata, this Ama takes Prasara to shleshma sthana and produces soft sandhiruja etc along with the symptoms of Ama.

Sthana Sanshraya: This prasarita Ama, a viscous and oily guru, maintains sthana sanshrya leading from Hridya, Trika Sandhi and Sarvanga to dosha-dushya Sammurchane.In the beginning, no symptoms appear at all, so only initial mild symptoms such as aruchi and apaka are observed, which can be seen as the purva rupa of this disease.

Vyakti: When the Vyakti stage is reached, most of the Amavata symptoms appear as Vrischik dansavata vedana. Stabdhata, etc. In the case of Adibala pravrita, kha-vaigunya is already present and in a mild form nidana-sevana disease appears.

Bhed: In chronic stage it reaches bhedavastha and produces updrava, khanjata like sankocha.

PANCHKARMA TREATMENT: Valuka Pottali Swed?-Given for 8 Days.

Pathya - Like Yava, Kulattha, Raktashali, Shigru, Karvellak, Patol, Aadrak, Lashoon, Jangal Mansa etc. Drink boil water.

Apathya - Dadhi, Guda, Kshir, Viruddha Bhojan, Abhishyandi and Picchila Dravya, Aanup Mansa,Vegavrodh and Jagaran etc.

Discussion

• Madhavkar was the first, who described the Chikitsa Siddhant for Amavata?. It includes Langhana, Swedana, drugs having Tikta, Katu Rasa and Deepana action, Virechana, Snehapana and Anuvasana as well as Ksharabasti. Yogaratnakara have added Upanaha without Sneha, to these therapeutic measures.
• Amavata is mainly caused due to vitiation of Vata Dosha and formation of Ama. Mandagni is the main cause of Ama production.
• Langhana has been mentioned to be the best measure for the treatment of Ama. Langhana in the form of Laghu Aahar was advised to the patient. Amavata is considered to be an Amasayotha vyadhi and Rasaja Vikara, Langhana is the first line of treatment in such conditions.
• Swedana have been specially indicated in the presence of Stambha, Gaurava and Shula. Swedana by its qualities like Ushna, Tikshna acts for stimulation in the body. It increases the metabolic rate in the body. Ushnaguna of Sweda dilates the capillaries thus it increases circulation.

• Valuka Sweda or Baluka Pottali Sweda is a form of swedana which is included under the category of Pinda Sweda (bolus fomentation). In this procedure we use heated sand tied in a bolus to provide heat to the afflicted joints or body parts, especially in diseases like Amavata (Rheumatoid Arthritis), Urustambha (stiffness of thigh and lower limbs), Medoroga (diseases manifested due to disturbances in fat metabolism) etc.The bolus is heated in a pan. The heated bolus is continuously rubbed over the afflicted area, low back in this case. In Amavata, Rukshasweda has been advocated in the form of Valukapottali due to the presence of Ama. It helps in pacifying vitiated Vata Dosha thus leads to relieve in Pain and stiffness.   The improvement in the symptom of Sthambha (stiffness) can be attributed to 2 major factors i.e. reduction of pain in joint and referred areas and due to increased nourishment to the joint. Sthambha is because of Strotorodha due to Aam, Kapha. Stabhaghna is important function of Swedana, Valuka have Ushana, Tiksna and lekhana gunas. Swedana with Valuka also shows effect on Shotha. It may be because of thermal effect of Valuka.
• Sinhnad Guggul -Mainly used for joint pain (Shool), swelling (Shoth), Stiffness (Graha) and inflammation associated with Rheumatoid arthritis.
• Punarnava Guggul -Punarnava helps to improve digestion to maintain proper pitta balancing deepana,pachan properties.
• Agnitundi vati -Used for promoting agni or the digestive fire for improved digestion.
• Aamvatari vati -Reduces swelling and relieves pain, Relieves Stiffness & Improves Joints Movement, Works as an Immuno-modulator, Prevents Degeneration of Joints.
• Gandharva Haritaki -It is used as anulomak and mridu vurechak.

Conclusion

From the above study we can conclude that this treatment partially or completely relives the sign and symptoms of Aamvata. These medicines and panchkrma procedure can be utilised for treating patients who are suffered from Aamvata to reduce both sign and symptoms effectively.