Rheumatoid Arthritis

Rheumatoid Arthritis (RA) & Amavata

Rheumatoid Arthritis (RA) in Ayurveda is widely correlated with the challenging disease known as Amavata. Amavata is regarded as a chronic inflammatory joint disease with multisystem involvement, posing a challenge for both modern and Ayurvedic physicians.

The term Amavata is derived from the combination of two words: “Ama” and “Vata“.

I. Ayurvedic Conceptualization: Ama and Vata

Ama Ama is defined as the unprocessed or undigested food particle. It results from the hypo-functioning of Agni (digestive fire/metabolic mechanism). This hypo-functioning (Mandagni) causes the first Dhatu (Rasa) to be improperly digested; instead, the undigested food material undergoes fermentation, often being retained in the Amashaya (stomach/upper digestive tract). This resulting product is considered toxic (visha padartha) in the body. Ama can also refer to the accumulation of mala (waste) or the first phase of Dosha vitiation.

Amavata Defined Amavata is a condition caused by the vitiation or aggravation of Vayu (Vata Dosha) associated with Ama. It results in Stabdhata (stiffness) of the body due to the lodging of vitiated Ama and Vata in the Trika Sandhi (sacral region) and other joints.

II. Etiology (Nidana)

The fundamental cause of Amavata is the simultaneous indulgence in unhealthy dietary and lifestyle factors (Viruddha Ahara-Vihara) in the presence of diminished digestive fire (Mandagni).

Key etiological factors include:

1. Mandagni (Decreased digestive power): This directly causes Ama formation due to improper digestion.
2. Viruddha Ahara (Incompatible food): Food that vitiates the Doshas without expelling them from the body, leading to Ama formation.
3. Viruddha Cheshta (Improper physical activity): Such as performing exercise immediately after eating.
4. Nischalata (Lack of physical activity/Sedentary lifestyle): Leads to vitiation of Agni and Ama formation.
5. Snigndham Annam Bhuktwa Vyayaamam: Exercising soon after intake of heavy or fatty food, which hampers digestion.

III. Pathogenesis (Samprapti)

The pathogenesis of Amavata begins with long-term Mandagni, which leads to the formation of Ama. This Ama is propelled by vitiated Vata Dosha and circulated all over the body through the bodily channels (Dhamanies). The Ama then lodges in the Shleshma Sthana (sites of Kapha), such as the joints (Sandhi).

The combination of Ama and vitiated Vata simultaneously enters the Trik region and other Sandhi (joints), resulting in stiffness and pain, which manifests as Amavata.

Samprapti Ghatakas (Pathogenic Components):

• Dosha: Vata Kapha Pradhana Tridosha.
• Dhatu: Rasa, Mamasa, Asthi, Majja.
• Srotas (Channels): Annavaha, Rasavaha, Asthivaha, Majjavaha.
• Udbhavasthana (Origin Site): Amashya (for Ama) and Pakvasaya (for Vata).
• Agni: Jatharagni Mandya (digestive fire impairment) and Dhatwagni Mandya (tissue metabolism impairment).

IV. Signs and Symptoms (Lakshana)

The symptoms of Amavata are closely related to RA.

Common Symptoms (Samanya Lakshana):

• Angamarda (Body ache).
• Aruchi (Anorexia/tastelessness).
• Trushna (Thirst).
• Gourav (Heaviness in the body).
• Aalasya (Lethargy/Malaise).
• Jwara (Pyrexia/Fever).
• Apaki (Indigestion).
• Anga-shunata (Swelling in the body).

Cardinal Symptoms (Pratyatma Lakshana):

• Sandhi shoola (Pain in the joints).
• Sandhi shotha (Swelling in multiple joints).
• Gatra stabdhata (Stiffness in the body/joints), particularly noticeable in the morning hours.
• Sparshasahyata (Tenderness above the joints).

Advanced Amavata (Pravriddh Amavata) may include pain like a scorpion sting (Vrishchikadanshavatavedana), and swelling/pain in the hands and feet (Ruja & Shotha in Hasta, Pada). If the swelling and pain affect all the joints, the management is considered very difficult.

V. Ayurvedic Management (Chikitsa)

The goal of treatment is to correct Agni, control Vata, digest Ama, and regulate Vata while maintaining healthy joints.

The standard line of treatment includes Langhan, Swedana, Tikta-Katu Deepan, Virechan, Snehapana, and Basti.

1. Panchkarma Therapy

Panchkarma modalities are highly effective as they possess Shroto-vishodhna (channel cleansing) effects.

• Langhana (Light Diet/Fasting): This is the first line of treatment to digest Ama. It involves the intake of light food rather than complete fasting.
• Swedana (Sudation/Fomentation): Ruksha Sweda (dry sudation, without oil or fat) is specifically recommended in Amavata. Techniques include using Valuka (sand) or Ruksha Pottali Sweda (sudation by medicated bolus) with substances like Eranda beeja and Saindhava salt. Snehana (oleation/oil massage) is generally contraindicated in Amavata. Swedana helps liquefy vitiated doshas and relieves stiffness, heaviness, and coldness.
• Virechana (Therapeutic Purgation): This procedure is recommended directly, without lengthy preoperative oleation. It utilizes substances like Eranda Taila (Castor oil) and Haritaki, which cleanse the channels (Sroto-Shodhaka) and relieve swelling and pain. Studies have shown that Virecana Karma followed by specific herbal treatments is highly effective in managing RA, improving general quality of life and enhancing drug efficacy.
• Basti (Medicated Enema): Considered the chief therapy for vitiated Vata. Kshara Basti and Anuvasana Basti are specifically mentioned. Yoga Basti (a regimen combining Matra Basti and Asthapana Basti) is also employed, targeting the Vata in its main seat, the Pakvasaya.

2. Shaman Aushadhi (Palliative Medicines)

Drugs possessing Katu (pungent) and Tikta (bitter) Rasa and acting as Deepana-Pachana (carminative/digestive) are recommended.

VI. Diet and Lifestyle (Pathya and Apathya)

Dietary modification and lifestyle habits are crucial for minimizing inflammation and preventing toxin build-up (Ama accumulation).

Apathya (Foods to Avoid): The diet should avoid foods that are heavy, cold, oily, and hard to digest, as these exacerbate Kapha and increase Ama.

• Newly harvested rice (heavy to digest).
• Black gram (Urad dal) (slow digestion, promotes Ama and purines).
• Curd (Yogurt) (aggravates Kapha, causes stiffness).
• Dairy products (milk, cheese, butter).
• Red and processed meats, fish (especially processed and fried).
• Sugar and jaggery.
• Cold, oily, and processed foods; fast food, chips, and sodas.
• Nightshades (tomatoes, potatoes, bell peppers, eggplant).

Pathya (Foods to Include): Include light, warm, and easily digestible foods to strengthen digestion and detoxification:

• Red Rice (Raktashali) and Barley.
• Horse gram (high protein, detoxification, reduces swelling).
• Lukewarm water (aids digestion and detoxification).
• Spices: Garlic, Wet Ginger, Turmeric, and Cumin (for anti-inflammatory effects).
• Buttermilk (source of probiotics).
• Castor oil (lubricates joints, alleviates stiffness).

 

Lifestyle Guidelines: Maintain warmth, practice gentle movements like yoga or stretching, avoid daytime sleeping, and avoid late-night wakefulness. Dry fomentation (Ruksha Sweda) and castor oil massage are also recommended for joint stiffness.