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By

Dr. Pravin Verma


Consultant Ayurveda Physician And Panchkarma specialist

Jain Hospital – Pandeypur, Varanasi-2, U.P. INDIA. PH - +91 542 3252795


Amavata (Rheumatoid Arthritis) is an Autotoxic,
Nonsuppurative, psychosomatic, proliferative,
Type III immune mediated, inflammatory
Disease.
According to Ayurveda RA may be compared with
Amavata.
Rheumatoid Arthritis affects through out the world
without any influence of climate, altitude and
Geography, with female to male ratio of 3:1.
Every year about 0.02% new cases are reported.
Jain Hospital – Pandeypur, Varanasi-2, U.P. INDIA. PH - +91 542 3252795
Unknown Provoking Factors
Non-specific immune response

Inflammatory lesion

IL-1, IL-6 &IL-8


From macrophages IL-2, IL-6 & IFN-γ OFR & hydrolytic
& Fibroblasts From T-Cells Enzymes from
Neutrophils

Continued inflammation RHEUMATOID ARTHRITIS


& Joint destruction
Jain Hospital – Pandeypur, Varanasi-2, U.P. INDIA. PH - +91 542 3252795
Synovial pannus
eroding articular cartilage.

Swan neck deformity


of the fingers

Courtesy by-
Davidson’s Principles and Practice Of Medicine.
Jain Hospital – Pandeypur, Varanasi-2, U.P. INDIA. PH - +91 542 3252795
Systemic Involvement Of RA
Systemic effect : Fever, weight loss, fatigue.
Musculoskeletal : Muscle wasting, tenosynovitis, bursitis
osteoporosis.
Hematological : Anaemia, thrombocytosis, eosinophilia.
Lymphatic system : Splenomegaly, Felty’s syndrome.
Eye : Episcleritis, scleritis, scleromalasia, keratoconjunctivitis sicca.
Cardiovascular : Pericarditis, myocarditis, endocarditis, digital arteritis
conductiondefects, coronary vasculitis, ulcers,
granulomatous arteritis, visceral arteritis,
Respiratory system : Nodules, pleural effusion, fibrosing alveolitis,
bronchiolitis, Caplan’s syndrome.
Nervous system : Cervical cord compression, amyloidosis,
compression neuropathies, peripheral neuropathy,
mononeuritis multiplex.
Jain Hospital – Pandeypur, Varanasi-2, U.P. INDIA. PH - +91 542 3252795
PAIN PATHWAY
Mechanical Thermal Chemical

Small Small
Myelinated Unmyelinated
Aδ fibers C fibers

sharp-fast pain
slow-chronic pain
velocity of 6-30 m/sec.
velocity of 0.5-2.0 m/sec.

Jain Hospital – Pandeypur, Varanasi-2, U.P. INDIA. PH - +91 542 3252795


Effect Of Blood Supply On Pain
Blood Supply Occluded In Muscle

Tissue Ischemia

Rise of Concentration Of
Lewis’s “P Factor”

Muscle Contraction

Pain
Jain Hospital – Pandeypur, Varanasi-2, U.P. INDIA. PH - +91 542 3252795
ETIOLOGY OF RHEUMATOID ARTHRITIS
ETIOLOGY

EXTERNAL INTERNAL BOTH

TOXINS
AGRAVATION &
OF FREE RADICALS
VATA
KAPHASTHANA

STOMACH TRIKASANDHI NECK

CHEST FOREHEAD

Jain Hospital – Pandeypur, Varanasi-2, U.P. INDIA. PH - +91 542 3252795


Sign & Symptoms
According To Madhava Nidan
1. Anga Pida (Body Ache)
2. Aruchi (Anorexia)

3. Pipasa (Thirst)
4. Aalasya (Fatigue)
5. Anga Gaurava (Heaviness In Body)
6. Jwara (Fever)
7. Burning & Redness If Pitta Is Associated

8. Heaviness & Itching If Kapha Is Associated

Jain Hospital – Pandeypur, Varanasi-2, U.P. INDIA. PH - +91 542 3252795


Diagnostic Criteria
1. Morning stiffness.
2. Joint tenderness (pain in motion).

3. Swelling of three or more joints from six months or more.


4. Arthritis of hand joints from six weeks or more.
5. Symmetrical arthritis from six weeks or more.
6. Rheumatoid nodules.
7. Rheumatoid factor.
8. X-Ray changes.
Diagnosis of Rheumatoid Arthritis in patients enrolled for present study
was based on the criteria of American Rheumatoid Association. Presence
of any of four of the above criteria was conformed the diagnosis.

Jain Hospital – Pandeypur, Varanasi-2, U.P. INDIA. PH - +91 542 3252795


Selection Of Patients & Grouping
72 patients

Group A (33) Group B (39)

Sub-group A1 Sub-group A2 Sub-group B1 Sub-group B2


(14) (19) (15) (24)

Jain Hospital – Pandeypur, Varanasi-2, U.P. INDIA. PH - +91 542 3252795


Plan Of Treatment

Group A – Treated with Oral Medicine as -


Amavatari Rasa 250 mg. BD.
Sanjeevani Vati 125 mg. BD.
And some other herbal medicines

Group B - Treated Along with above Oral Medicine &


Bahya Snehan with Mahavishagarbha Tail
Nadi Sweda with Dasamool Kwatha.

Jain Hospital – Pandeypur, Varanasi-2, U.P. INDIA. PH - +91 542 3252795


Snehana
Literally ‘Sneha’ means Oleate or to make smooth.
It produces Snehana (Unctuousness), Vishyandana (Fluidity),
Mrudutwa (Softness) and Kledana (Smoothness) in the body.

Snehana is of two types -


(1). Bahya (External)
(2). Abhyanatara (Internal)

Bahya Snehana (abhyanaga) improves the circulation.


This may helps in mobilizing the localised toxins in to the
systemic pool. After that these autotoxins may be eliminated
by different mechanisms.

Jain Hospital – Pandeypur, Varanasi-2, U.P. INDIA. PH - +91 542 3252795


Swedana
The process which relieves stiffness, heaviness, coldness and
which induces sweating is known as Swedana Karma.

Effect of Swedana are as follows –


• Improves digestive Power.
• Limbs become soft.
• Skin becomes smooth.
• Increases interest towards food.
• Channels will be cleared.
• Restores the function of the joints.

Due to Swedana (sudation), vitiated doshas can be brought


back to the Kostha and can be eliminated by means of elimination
therapies.
Jain Hospital – Pandeypur, Varanasi-2, U.P. INDIA. PH - +91 542 3252795
Assessment of clinical symptoms

The patients were assessed with the following clinical


symptoms before and after the treatment –

1. Pain
2. Swelling
3. Stiffness
4. Grip power
5. Walking time
6. Appetite
7. Fever

Jain Hospital – Pandeypur, Varanasi-2, U.P. INDIA. PH - +91 542 3252795


SCORE OF PAIN IN RHEUMATOID ARTHRITIS

2.5

1.5 Before Treatment


After Treatment
1

0.5

0
A1 A2 B1 B2

A1 & B1– Disease less than 3 Yrs.


A2 & B2 – Disease more than 3 Yrs.

Jain Hospital – Pandeypur, Varanasi-2, U.P. INDIA. PH - +91 542 3252795


SCORES OF SWELLING IN RA
3

2.5

1.5 Before Treatment


After Treatment
1

0.5

0
A1 A2 B1 B2

A1 & B1– Disease less than 3 Yrs.


A2 & B2 – Disease more than 3 Yrs.

Jain Hospital – Pandeypur, Varanasi-2, U.P. INDIA. PH - +91 542 3252795


SCORES OF MORNING STIFFNESS IN
RHEUMATOID ARTHRITIS
3

2.5

1.5 Before Treatment


After Treatment
1

0.5

0
A1 A2 B1 B2

A1 & B1– Disease less than 3 Yrs.


A2 & B2 – Disease more than 3 Yrs.

Jain Hospital – Pandeypur, Varanasi-2, U.P. INDIA. PH - +91 542 3252795


SCORES OF GRIP POWER
IN RHEUMATOID ARTHRITIS
3

2.5

1.5 Before Treatment


After Treatment
1

0.5

0
A1 A2 B1 B2

A1 & B1– Disease less than 3 Yrs.


A2 & B2 – Disease more than 3 Yrs.

Jain Hospital – Pandeypur, Varanasi-2, U.P. INDIA. PH - +91 542 3252795


NEGATIVE SCORES OF APPETITE
IN RHEUMATOID ARTHRITIS
3

2.5

1.5 Before Treatment


After Treatment
1

0.5

0
A1 A2 B1 B2

A1 & B1– Disease less than 3 Yrs.


A2 & B2 – Disease more than 3 Yrs.

Jain Hospital – Pandeypur, Varanasi-2, U.P. INDIA. PH - +91 542 3252795


NEGATIVE SCORES OF WALKING TIME
(Distance of 10 mts.) IN RHEUMATOID
ARTHRITIS
300

250

200

150 Before Treatment


After Treatment
100

50

0
A1 A2 B1 B2

A1 & B1– Disease less than 3 Yrs.


A2 & B2 – Disease more than 3 Yrs.

Jain Hospital – Pandeypur, Varanasi-2, U.P. INDIA. PH - +91 542 3252795


SCORES OF FEVER IN RHEUMATOID
ARTHRITIS
3

2.5

1.5 Before Treatment


After Treatment
1

0.5

0
A1 A2 B1 B2

A1 & B1– Disease less than 3 Yrs.


A2 & B2 – Disease more than 3 Yrs.

Jain Hospital – Pandeypur, Varanasi-2, U.P. INDIA. PH - +91 542 3252795


Between The Group Comparison (Unpaired ‘t’ Test)
Group A(N=33) Group-B (N=39) Value of
Criteria
Mean SD Mean SD t&p

t = 2.33
Pain 0.4242 ± 0.5019 0.1795 ± 0.3888
p<0.05 S

t = 2.05
Swelling 0.4545 ± 0.6170 0.2051± 0.4091
p<0.05 S

t = 3.80
Stiffness 0.4555 ± 0.5056 0.1538 ± 0.3655
p<0.001 HS
t = 4.09
Grip Power 0.5758 ± 0.5019 0.1282 ± 0.3387
p<0.001 HS
t = 0.86
Walking Time 81.30 ± 49.49 72.12 ± 40.79
p>0.05
t = 3.80
Appetite 0.5455 ± 0.5056 0.1538 ± 0.3655
p<0.001 HS
t = 4.49
Fever 0.5758 ± 0.5019 0.1282 ± 0.3387
p<0.001 HS

Jain Hospital – Pandeypur, Varanasi-2, U.P. INDIA. PH - +91 542 3252795


Conclusion and Results
Rheumatoid arthritis is an incurable disease and
present study concluding the following –

(1). In RA relief can be given with oral medicine.


(2). When Snehan and Swedan is added, the relief rate is
highly significant.
(3). Addition of Snehan and Swedan have proved its place in
the Ayurvedic managements.

So one can say the Sansodhana treatment are essential for


better management of Rheumatoid arthritis.

Jain Hospital – Pandeypur, Varanasi-2, U.P. INDIA. PH - +91 542 3252795


Jain Hospital – Pandeypur, Varanasi-2, U.P. INDIA. PH - +91 542 3252795