Rheumatoid Arthritis is a Joint Disorder, which affects Multiple Joints at various sites. It is described as "Amavata" in Ayurveda.

The word Ama' means Toxic material generated as a un wholesome product in the body due to weakening of digestive fire. This Ama' is then carried by Vayu' and travels throughout the body and accumulates in the joints, which is the seat of Kapha'. As this process continuous, all the Joints are gradually affected, which results in Severe Pain and Swelling in the Joints. When Pitta' also gets aggravated, it causes Burning Sensation around the Joints. General Clinical Features: "Angamardaaruchistrushna alasyam gouravam jwara! Apaka sunyatanganam amavathasya lakshnam!!"

Body Pains Lack of Taste Thirst General Weakness Feeling of Heaviness Fever Morning stiffness of the Joints Pain and swelling in the affected parts Shifting of pain in Joints Constipation Indigestion

Ayurvedic Management of Amavata: a. Ahara Chikitsa or Dietary regimen:

One should take Old Rice, Butter Milk, Wet Ginger, Garlic, Wheat, Bitter gourd and Horse Gram in his diet. Avoid consumption of Dairy products, Sweets, Oily foods, Chinese Food, Junk and Fast Foods, Salty and Sour Foods, Jaggery, Black Gram, Fish, Cold Drinks and Ice Creams. b. Vihara Chikitsa or Life Style Modifications: One should avoid Cold Breeze and Excessive Wind. Bathing with cold water should be strictly avoided. Warm water bath is recommended. It is also advisable to take a gentle walk after consumption of food. Also it is good to avoid water intake immediately after consuming food. c. Aushadha Chikitsa or Drug Therapy: Guggulu' is the most effective drug in treating Amavata'. Also herbal preparations of Ashwagandha, Haritaki, Rasna, Sunthi, Pippai and Trivrut are helpful in Amavata'. Administration of caster oil is also very effective in this disease. The mentioned drugs should be taken only after consulting a Qualified Ayurvedic Physician. d. Panchakarma Chikitsa or Detoxification Procedures: This is a purification procedure. By taking this Therapy Toxins are eliminated from the body. The course is as follows: 1. Snehana:

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Internal and external oleation to the body / affected parts is given as a preliminary process. 2. Swedana:

This is done by application of steam on the affected parts. It helps in reducing inflammatory conditions in the body. Especially in Amavata' fomentation with sand bag is recommended. Sankara Sweda is also very helpful. In chronic cases Shali shasthika pinda sweda is recommended. 3. Virechana Karma: It is a type of Purgation which is induced by oral intake or herbal compound preparations. By the process of Virechana, the Ama' is eliminated from the body. Also the bowel is cleansed, which results in proper absorption and assimilation of the medicinal preparations properly. 4. Vasthi karma: This is done by administration of herbal enema. It is helpful in chronic cases. Kashaya Vasthi, Anuvasana Vasthi and Matra Vasthi etc are planned according to the Patient's requirement and necessity. Ayurvedic Treatment for Amavata lasts for 14to28 days depending upon the severity of the disease, patient's Constitution (Prakruthi). We at THE KERALA AYURVEDIC CARE, Speciality Panchakarma Centre, 3-6-101/1, St no: 19, Basheerbagh, Hyderabad-29 have Treated Thousands of Patients with 99% results. Speciality Treatments are being done from the past 9 Years. For the Services in the field of Ayurveda, Dr. Kranthi Vardhan, the Chief Physician & the Managing Director, has been awarded "KKRUSHI RATNA AWARD", "AYURVEDA TAPASWI AWARD", and "VAIDYA RATNA AWARD". Care of Joints in Amavata' 1. Physical activities causing pain in the joints should be avoided. 2. Staying in one position for too long should be avoided. 3. Good posture of the Joints should be maintained. 4. One should sleep on a firm mattress or bed. 5. Weight should be controlled as excess of weight adds stress to the joints. 6. Exercise is very important to keep the joints in working condition. Preventive aspects: It is always better to take Preventive Measures before a disease affects us. In order to prevent Amavata' care should be taken to avoid Sedentary Habits. Also one should perform Daily Exercises or Yoga. One should also avoid Heavy, Viscous and Incompatible foods. Instead one should take High-fibre and Low Fat Diet. Care should also be taken to keep our Digestive Fire intact, as the case of all diseases is the weakening of digestive fire.

Osteoarthritis An Ayurveda Management

Osteoarthritis which is a common suffering these days could be compared to Sandhi gata vata from Ayurvedas perspective. Though it is difficult to have a comparative study of two very different systems, but for the ease of understanding and to bring the best out of the two system for achieving a common a goal of curing the ailments, an integration is not a bad idea. Osteoarthritis is a disease characterized by a group of mechanical changes with the degeneration of joints. It is a prevailing disorder in old age people, wherein level of calcium degrades due to an effect of ageing, but other factors like life style, food habits etc. are also equally responsible for the prevalence of this disease. Ayurveda describes a long list of causative factors responsible for Sandhi Gata Vata. As the name suggests, it is a disorder generated by excess Vata thus also known as Vata Vyadhi. Though vata vyadhi is quite a comprehensive term and it is a group of diseases created by increased Vata out of which one that affects joints specially weight bearing articulations is named a Sandhi Gata Vata. Meaning of word Sandhi is Joint or articulation.

Sandhi Gata Vata can affect any of the joint, but mostly large weight bearing joints like hip, knee and ankle are affected. Vata, which is a factor chiefly responsible for the mobilization in the body when increases in excess starts degenerating the body by means of its property of absorption. Symptoms of increased Vata can be viewed by signs of dryness over the skin, wrinkles, loosening of the joints, muscle wasting, poor strength etc. As per Ayurveda, causative factors responsible for the vitiation of Vata are, too much consumption of food which is dry in nature, and light to digest, to eat small

quantity of meals which is insufficient for the body for a prolonged duration, too much involvement in sexual activities, to consume insalubrious diet, to wake up late night and to remain hyperactive and physically involved without taking enough rest. Chronic indigestion, malnutrition, excessive travelling are also few factors responsible for the vitiation of Vata Dosha. Trauma, excessive bleeding, chronic stress are also few other factors that increase Vata. Vitiated Vata when enters into the channels, it initiates many ailments related to Vata, and one of them is Sandhi Gata Vata. Sandhi Gata Vata mainly represent symptoms pain and stiffness in the joint that may or may not increase with exertion. The joint makes a peculiar crackling sound while moved which is also called as crepitus. Swelling of the joint after exertion with or without the signs of inflammation can also be seen. Sandhi Gata Vata mainly affects spine, hip, knee and ankle joints which undergo a lot of wear and tear generated by body weight.

So obese people are at more risk of having osteoarthritis. Generally pain increases with cold and patient feels relieved by hot fomentation. Diagnoses can be established based on history and clinical examination. X- ray can consolidate the diagnoses and a typical OA(knees) X- ray film shows degenerative changes in the knee joint with joint space reduction and osteophyte formation in the joint. Management of Sandhi Gata Vata from Ayurvedas perspective is quite interesting and effective as well. One needs to rule out the involvement of the toxins (ama). Ayurveda reveals that sometimes Ama involvement with excessive Vata generates similar symptoms to the Ama Vata and could be

quite confusing to diagnose, this state is called as Sama Sandhi Gata Vata. In such cases fasting remains the first line of action and it is necessary to bring it to the state of Nirama that is free from the toxin. There on line of action remains Oleation and fomentation to the joint, which could be done with the help of Panchakarma. Specific herbal oils are used for the purpose of oleation followed by fomentation with the help of herbal decoction prepared with the herbs that pacify Vata and also relieves the pain. Herbs like cida cordifolia (Bala), Gingiber offcinale (Shunthi), Cedrus deodara (Devdaru) are few that also helps in Sandhi Gata Vata. Food and nutrition is an aspect that can not be set aside while treating osteoarthritis. Life style needs to be corrected to achieve maximum result. It should be kept in mind that it is of utmost important to manage OA and if managed earlier it is better.

Vatarakta & Gout. VATARAKTA(GOUT).

Vatarakta is the disease related with khavaigunya found in Raktavaha srotas which includes vitiated Vata and blood. 1) NIRUKTI: 2) VYAKHYA: Vitiated blood gravitates and accumulates in the feet. Thereafter, it gets saturated with the deranged vayu, on account of the predominance of which it is called as Vatarakta. 3) HETU:- Excessive intake of salty, sour, pungent, alkaline, fatty and hot food, taking meals while one is having indigestion, curried or fried preparations of meat of aquatic or swampy animals, dried meat and cereal ball preparations, radishes, kulattha, masha, nishpava, different varieties of leafy vegetables and meat, sugarcane and yoghurt, arnala (Kanji or sour fermented rice water), sauvira (sour fermented barley water), sukta (vinegar), buttermilk, wine and asava (medicated spirit, eating incompatible articles of diet, eating before the previous meal has been digested, anger, day sleep and keeping awake at night. The factors responsible for Gout according to modern science are as follows: a) Increased serum uric acid concentration (hyperuricaemia). b) Recurrent attacks of characteristic type of acute arthritis in which crystals of monosodium urate monohydrate may be demonstrable in the leucocytes present in the synovial fluid.

c) Aggregated deposits of monosodium urate monohydrate (tophi) in and around the joints of the extremities. d) Renal disease involving interstitial tissue and blood vessels. e) Uric acid nephrolithiasis. 4)PURVARUPA:-The general prodromal symptoms and signs of Vatarakta are profuse perspiration or anhidrosis, blackish discolouration, loss of the sense of touch, severe pain on even mildest trauma, slacknes of the joints, indolence and malaise; the local appearance of eruptions on the knees, legs, thighs, loins, shoulders, hands, feet and the joints of the body, severe pricking type of pain, twitchings, tearing pain, heaviness, numbness and an itching sensation, pain in the joints which comes and goes again and again, local discolouration and circumscribed patches also occur. 5) RUPA:6) PRAKARANURUPA RUPA :-1) (a) Superficial type (Uttana):- Affected skin becomes blackish red, painful, hot to touch and there is intensive itching. The skin becomes black coloured. (b) Deep type (Gambhira):- There is swelling, hardness, severe pain, burning and pulsations in the affected parts. The symptoms are more prominent in the bones, nerves and muscles. Charaka has accepted these two as the type of diseases, while Sushruta accepts these two as the stages of the disease. 2) (a) Vatarakta with predominance of vata:- With predominance of vata, there is excessive pain, twitching and splitting sensation

in the lesions. The inflammatory swelling is dry, black or blackish and increases or decreases at times. The arteries and the joints of the fingers and toes become narrow and severely painful. There is an aversion and intolerance to cold as well as rigidity, tremors and numbness in the limbs. (b) Vatarakta with predominance of rakta: - With the predominance of rakta, there is severe pain as well as pricking and tingling sensations in the inflammatory swelling which is coppery red and is associated with an itching sensation and a moist discharge; it subsides neither with fatty nor with dry medicaments. (c) Vatarakta with predominance of pitta: - With the predominance of pitta, one suffers from heart burn, mental confusion, perspiration, fainting, intoxication and thirst; there is hyperesthesia, severe pain, redness, excessive heat and suppuration in the inflammatory swelling. (d) Vatarakta with predominance of kapha: - With the kapha predominance, the body is felt as if covered with wet clothes, heavy, insensitive to touch, oily and cold. There is an itching sensation and mild pain locally. (e) Vatarakta with predominance of two/ (f) Three doshas: - With the predominance of two doshas or of all doshas, mixed features of the concerned doshas are present. 7) SAMPRAPTI: - Riding on an elephant, a horse or a camel and an intake of heart-burn producing articles of diet causes improper digestion of food leading quickly to vitiation of Vata and Rakta, which then gravitates and accumulates in the feet.

Thereafter, the vitiated blood gets saturated with the deranged vayu, on account of the predominance of which it is called as Vatarakta. Since, in Vatarakta both Vata and Rakta gets vitiated, both are responsible for each others vitiation. The vitiated Vata vitiates Rakta during the flow of Rakta along with Vata; whereas vitiated Rakta vitiates Vata by blocking its channels and so on. Clinically, the natural history of gout comprises 4 stages: asymptomatic hyperuricaemia, acute gouty arthritis, asymptomatic intervals of intercritical periods and chronic tophaceous stage. In addition, gout nephropathy and urate nephrolithiasis may occur. Gout may be classified into 2 types: metabolic and renal, each of which may be primary or secondary. Primary refers to cases in which the underlying biochemical defect causing hyperuricaemia is not known, while secondary denotes cases with known causes of hyperuricaemia. a) Hyperuricaemia of metabolic origin: Comprises about 10% cases of Gout; characterized by overproduction of uric acid. There is either an accelerated rate of purine biosynthesis de novo or an increased turnover of nucleic acids. b) Hyperuricaemia of renal origin: - Comprises about 90% cases of Gout, characterized by reduced renal excreation of uric acid. Altered renal excreation could be due to reduced glomerular filteration of uric acid, enhanced tubular reabsorption or decreased secretion. According to both ancient and modern sciences, the vitiation predominantly starts in the great toe and starts flowing upwards just like the rat poison (it may also floe from thumb to upwards).

8) DOSHA-DUSHYA ADHISTHAN: - a) Dosha: Vatapradhan; b) Dushya: - Rakta; c) Srotus: - Raktavaha; d) Adhishthan: - Sandhi; e) Srotodushti lakshana: - Sanga; f) Pakvashayotth: - Chirakari roga. 9) UPADRAVA: - There may arise various complications in this disease such as insomnia, anorexia, dyspnoea, sloughing, fixity at the joint of neck, fainting, pain, thirst, fever, mental confusion, tremors, hiccough, inability to walk, spreading cellulites, suppuration, pricking pain, dizziness, tiredness, digital deformities, appearance of blisters, burning sensation, affection of the vital organs mainly heart, rectum and brain (hrudaya-basti-shira) and tumours and even the mental confusion. If all the complications have not appeared, the condition is relievable, whereas if there is no complication at all it is curable. 10) UDARKA:11) ARISHTA LAKSHANA:12) VYADHI VYAVACHCHHATI: 13) SADHYASADHYATA: a) Ekadoshaja and recent Vatarakta are easily curable. b) Dvidoshaja Vatarakta, Vatarakta persistent for one year even along with the complications are yapya ;i.e.; difficult to cure. c) Tridoshaja Vatarakta along with lots of complications is incurable. Also those Vatarakta in which the disease has been spread from thumb to the janusandhi or in which skin has become worst affected or in which there exist secreations from the skin or in

which there are complications such as kshaya of strength or mansa dhatu are incurable.

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