AMAVATA (RHEUMATOID ARTHRITIS)

Amavata is  correlated with modern diagnosis of Rheumatoid Arthritis. It is a condition involving multiple joints of the body. In modern medicine It is considered as an autoimmune disease giving rise to deformities of joints in extreme conditions.It comes as attacks of shifting or pricking type of pain , stiffness particularly in morning hours, person may feel comfortable for many days and has sudden active phase of the disease. As per modern medicine, there is symptomatic cure available for this condition.

Ayurveda has remedies for cure and preventing the further progression of the disease.There are effective and safe herbs as well as therapies available in Ayurveda for this conditions. The Ama or toxins present in the body, which are responsible for causing the disease can be removed and vitiated Vata can be pacified with the help of Ayurveda Panchakarma therapies.
Let us know what Ayurveda says about this disease:

Etymology of Amavata :-

According to above derivation the words Ama ( toxins from undigested food or undigested food juice) and Vata combine to form Amavata. It means, Vata Dosha along with Ama is termed as Amavata. It indicates the propulsion of Ama by vitiated Vata in the entire body and getting lodged in Sandhisthana (joints) producing Amavata.
 

Pathophysiology  of Amavata as per Ayurveda:-

When Ama and Vata simultaneously gets vitiated and enters the Trika(Pelvic girdle) and Sandhi( Joints) finally leading to stabdhata (stiffness) of the body, the condition is known as Amavata. To our opinion Trika can also be taken as joints where more than two bones unite to form an anatomical structure and Sandhi can be taken as where two structures unite to form an anatomical structure.
Rheumatoid Arthritis is a chronic systemic inflammatory disorder that may affect many tissues and organs, skin, blood vessels, heart, lungs and muscles, but principally attacks the joints, producing a non-suppurative proliferative synovitis that often progresses to destruction of the articular cartilage and ankylosis of the joint.

Definition of Ama and Vata :-

The word Ama is derived from the Ama Dhatu with the Suffix A. It means improper or partially digested matter. Due to poor strength of Agni (Jatharagni/digestive fire), Rasa the first dhatu is incompletely formed and remains of this incomplete  & undigested remains of Rasa in Amashaya(digestive system) is known as Ama.
Other meanings of this word (Ama) found in Ayurvedic literature are :-
• incompletely, fermented and unripened substances (Ch.Su.25)
• unbaked and incompletely developed substances (Ch.Sha.8)
• Unprocessed substances or unprocessed metabolites in context to the body (Ch.Su.4.)
Vata is the chief functional operator of  all types of bodily movements. All type of movements whether voluntary or involuntary are possible only under the influence of Vata Dosha.

NIDANA OF AMAVATA (Etiological Factors)

Acharya Sushruta has emphasized that the simple baseline of treatment is to exclude the Nidana. It is rightly said 'Prevention is better than cure'. Hence the knowledge about Nidana (etiological factors) is very essential to provide proper guidance for therapy as well as in the prevention of the disease.

• Viruddha Ahara (unwholesome diet)
• Viruddha Chesta (erroneous habits)
• Mandagni (diminished Agni)
• Nishchalata (sedentary habits),
• Any type of exertion immediately after taking Snigdh Ahara (oily food) are the main aetiological factors responsible for production of Amavata.
• Excessive indulgence in Guru Ahara (heavy food) and Kandashaka(tuberous vegetables).

These above said causative factors responsible for Amavata affect the body in following ways:-

1. Viruddha Ahara( Inimical Food):-

Those articles of diet which are inimical to the body elements (Sharira Dhatu) tend to disagree with the system are known as Viruddha. Viruddha Ahara is one of the most important factor responsible for Amavata. Eighteen types of Viruddha Ahara or inimical food combinations have been described in Charaka.

• Desha Virrudha (Habitat opposed)
• Kala Virrudha (Time or Season opposed)
• Agni Viruddha (Power of Digestion opposed )
• Matra Viruddha (Quantityopposed )
• Satmya Viruddha (Homologationopposed)
• Dosha Viruddha (Against Vatadiopposed)
• Sanskara Viruddha (Mode of preparationopposed)
• Virya Viruddha (Potencyopposed)
• Kostha Viruddha (Bowel tendencyopposed)
• Avastha Viruddha (State of the patientopposed)
• Krama Viruddha (Orderopposed)
• Parihara Viruddha (Things to be avoidedopposed)
• Upachara Viruddha (Prescriptionopposed)
• Paka Viruddha (Cookingopposed)
• Samyoga Viruddha (Combinationopposed)
• Hrita Viruddha (Palatabilityopposed)
• Sampata Viruddha (Richness of qualityopposed)
• Vidhi Viruddha (Rules of eating opposed) (Ch. Su. 26/86-87)

Excessive indulgence of any of these Viruddhahara leads to production of Ama and Vitiation of Vata, ultimately leading to Amavata.

2. Viruddha Chesta(erroneous habits):-

As per the Ayurvedic classics following should be considered as Viruddha Chesta.

• Exertion soon after taking unctous meal.
• Taking Ushana and Sheeta substances immediately one after another.
• Sedentary lifestyle.
• Suppression of natural physiological urges (Vegavidharana)
• Day time sleeping (Divasvapa)
• Awakening at night (Ratrijagarana )
• Performing such acts which are beyond one's capacity (Sahasa)
• Excessive indulgence in sexual act. (Atimaithuna)
• Any type of physical involvement just after taking meal viz exercise, sexual act,
horse riding etc.
• Cold water bath (Sheetodaka Snana )
• Exposure to excessive winds due to excessive travelling or excessive indulgence into adventurous hobbies like sky diving, scuba diving etc
• Sleeping on an uneven bed.

3. Mandagni ( Low appetite) :-

Sluggishness of Agni takes place due to its own causes which results in production of Ama.

4. Nishchalata(hypo activity) :-

Any type of physical inactivity or state of inertia is responsible for Kapha Vriddhi which results in Agnimandya(reduced digestive fire) and consequently results in the formation of Ama.

5. Snigdha Bhuktvato Vyayama(Indulgence into heavy physical activity just after eating unctous or heavy food) :-

Though exercise just after any type of meal is unhealthy, but exercise after taking unctous meal (Snigdha Ahara) has been specially mentioned in causation of Amavata. Here exercise means any type of rigorous physical activity. Normally a good blood supply is very essential in gastro-intestinal tract for the digestion of heavy meal. But when a person indulges in any type of heavy physical activity just after consuming meal, blood circulation to the skeletal muscle increases resulting in decrease of blood supply to the gastro-intestinal tract comparatively. By this act the process of digestion, absorption & assimilation gets seriously hampered. Therefore improper digestion leads to formation of Ama, which is the foremost pathological factor of Amavata. Thus table manners, regular timings and showing respect towards the eatable food by eating by sitting quietly at one place, etc. play a vital role for maintenence of good health.

6. Miscellaneous Causes :-

• A habbit of eating tubers and roots frequently in food (Kandamula Sevana) has also been mentioned as the causative factors of Amavata.
• Other pathological factors (Nidanarthakar Roga) :- Many other disorders such as Garbhasrava( frequent Miscarriages),Garbhapata( Frequent Abortions), Unnatural or surgical deleivery of baby in women, Pandu(anaemia) etc. may play as a causative factor fo Amavata.
• Psychological factors :- In state of Atichinta(excessive stress), Atishoka( excessive Grief ), Krodha(excessive anger), Bhaya(excessive fear) if a person is habituated to  take meal, then proper digestion will not take place because for improper secretion of intestinal juice. A healthy mental state is very necessary to avoid Amavata.

PRATAYATAMA RUPA - (Cardinal signs & Symptoms of Amavata)

i. Sandhi Shoola (Pain in Joints)
ii. Sandhi Shotha (Swelling in Joints)
iii. Stabdhata (Stiffness in joints)
iv. Sparshasahatva (Tenderness in joints)
v. Sashabda Sandhi (Crepitation on movement of the joints)

Apart from these cardinal symtoms Angamarda (Generalised body ache), Aruchi ( Anorexia), Trishana (Thirst), Alasya(laziness), Gaurava (Feeling of heaviness in the body), Jvara (Fever), Apaka (Indigestion) , Angasunnata(numbness) are also found.

CHIKITSA SIDHANTA (Line of Treatment)

1. Langhana (Fasting)- Intake of very light food

2. Svedana(Sudation therapy) :- Svedana is the process which causes perspiration, destroys stiffness, heaviness of the body and cold. Rukshasveda (dry fomentation) is indicated meaning without use of steam or oil massage. Other type of Svedana which is good in case of Amavata is internal administration of Ushana Jala (hot water).

3. Tikta-Katu and Deepana Dravyas:- Bitter,& Pungent tasting foods are useful in igniting the appetite and help digest Aama  e.g- Shunthi (dry Ginger), Chitraka, Guduchi, Pippali(long pepper), Maricha(Black pepper) etc.

4. Virechana:- Virechana is a therapy which is indicated in Ayurvedic Panchakarma for detoxification.

5. Snehapana :- The therapeutic measures so far employed are likely to cause Rukshata(dryness) in the Dhatu and provocation of Vata which may result in further aggravation of disease process in a chronic stage. This can be well controlled by administration of Sneha(unctuousness) as per the advice of the Ayurvedic physician

6. Basti :- In Amavata both Anuvasana (oil enema) as well as Asthapana Basti(decoction enema) are recommended. Chakrapani Ayurveda  recommends Saindhavadi Taila for Anuvasana Basti and Kshara Basti for Asthapana Basti.