Amavata kc009 hyd

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A clinical study of the effect of ajamodadi yoga with shallaki in the management of amavata, Binod Kumar singh. 2007, Dr. N.T.R UNIVERSITY OF HEALTH SCIENCES, VIJAYAWADA, Dr.B.R.K.R. Govt. Ayurvedic College, HYDERABAD

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Amavata kc009 hyd

  1. 1. A CLINICAL STUDY OF THE EFEECT OF AJAMODADI YOGA WITH SHALLAKI IN THE MANAGEMENT OF AMAVATA Dissertation submitted in partial fulfilment for the degree of DOCTOR OF MEDICINE (AYURVEDA) In KAYACHIKITSA By Dr.Binod Kumar singh. B.A.M.S GUIDE Dr. V. VIJAYA BABU. M.D. (Ay.) Reader Postgraduate Department of Kayachikitsa Dr. B.R.K.R. Govt.Ayurvedic College, Hyderabad. Dr. N.T.R UNIVERSITY OF HEALTH SCIENCES VIJAYAWADA Dr.B.R.K.R. Govt. Ayurvedic College, HYDERABAD 2007
  2. 2. “Namami Dhanvantarimadi Devam, Surasurairvandit Padapadmam | Loke Jararugbhay Mrutyunasham,Datarmisham Vividhoushadhinam ||”
  3. 3. Dr. N.T.R. UNIVERSITY OF HEALTH SCIENCES VIJAYAWADA POST GRADUATE TRAINING AND RESEARCH UNIT DEPARTMENT OF KAYACHIKITSA Dr. B.R.K.R. GOVT. AYURVEDIC COLLEGE / HOSPITAL HYDERABAD CERTIFICATE This is to certify that the present dissertation embodies the outcome of originalobservations made by Dr. Binod Kumar Singh on ‘A Clinical Study of the effectof Ajmodadi yoga with Shallaki in the managemant of Amavata’ for thedegree of ‘Doctor of Medicine’ (Ayurveda). This work has been completed undermy direct supervision after a series of a scientific discussion. The scholar has put in commendable effort for designing and executing the methodsand plans for the study. The results achieved through this work are authentic and reproducible.Hence I recommend this dissertation to be submitted for adjudication. GUIDEDate: Dr. V. VIJAYA BABUPlace: Hyderabad. MD (Ayu) Reader Post graduate Department of Kayachikitsa Dr. B.R.K.R. Govt. Ayurvedic College, Hyderabad.
  4. 4. Dr. N.T.R. UNIVERSITY OF HEALTH SCIENCES VIJAYAWADA POST GRADUATE TRAINING AND RESEARCH UNIT DEPARTMENT OF KAYACHIKITSA Dr. B.R.K.R. GOVT. AYURVEDIC COLLEGE / HOSPITAL HYDERABAD CERTIFICATE This is to certify that Dr. Binod Kumar Singh of M.D. (Ayu) Kayachikitsa hasworked for the thesis on the topic ‘A Clinical Study of the effect of Ajmodadiyoga with Shallaki in the managemant of Amavata’ as per requirements of theorder laid by the N.T.R. University of Health Sciences, for the purpose. The hypothesissubmitted by him in the first year MD (Ayu) is one and the same to that of the dissertationsubmitted. I am fully satisfied with his work and hereby forward the dissertation for the evaluationof the adjudicators.Date: Dr.PRAKASH CHANDERPlace: Hyderabad MD (Ayu) Professor& HOD, Post graduate Dept. of Kayachikitsa Dr. B.R.K.R. Govt. Ayurvedic College, Hyderabad.
  5. 5. LIST OF ABBREVIATIONS A.H. = Astanga Hridaya. WHO = World Health Organization. B.C. = Before Christ. A.D. = After death. R.V. = Rig Veda. A.V. = Atharva Veda. M.Bh. = Mahabharata Ma.Ni. = Madhava Nidana. Cha. Chi. = Charaka samhita chikitsa sthana. Ra.Ni. = Raj Nighantu. A.H.U. = Astanga Hridaya Uttartantra S.K.D. = Sabda Kalpadruma. Su. = Sushruta Samhita Ch. = Charaka Samhita. Ha. = Hareeta Samhita. B.P. = Bhava prakasha. Bh.R. = Bhisjyaratnawali. C.D. = Chakradatta. V.Y.Ch. = Vaidya yoga chintamani. Ni. = Nidana sthana.Sa. = Sareera sthana.Vi. = Vimana sthana.B.T. = Before treatment.A.T. = After treatmentY.R. = Yoga ratnakara.
  6. 6. ACKNOWLEDGEMENTAt this unforgettable moment, I prostrate my head on the feet of our aradhya deva BABAPASHUPATINATH for deputing me to serve the mankind.I take utmost pleasure and feel privileged to express my deep sense of gratitude andextreme indebtedness to my Guru and Guide Dr. V. VIJAYA BABU, M.D. (Ayu), Reader,Post Graduate Dept. of Kayachikitsa, Dr. B.R.K.R. Govt. Ayurvedic College, Hyderabadfor his constant and valuable guidance, encouragement throughout the dissertation work.Undoubtedly the correct, affectionate and untiring guidance of my Guru has been agreatest asset in its completion.I express my heartful gratitude to Dr. PRAKASH CHANDER, MD (Ayu), Professor andHOD, PG Dept. of Kayachikitsa, Dr. B.R.K.R. Govt. Ayurvedic College, Hyderabad, forhis constant support, guidance, encouragement and kind co-operation in all aspects.I convey my wholehearted thanks and sincere respect to Dr. M.L. Naidu, Reader, P.G.Dept. of Kayachikitsa for his support and kind co-operation throughout the study.I take this opportunity to express my sincere thanks to Dr P. Nageswar Babu, Dr. S.Ramalingheswar Rao and Dr. VijayaLakshmi, Technical Assistants, Post GraduateDepartment of Kayachikitsa, for their kind co-operation in my clinical work.I am highly indebted to Dr. M. Srinivasulu, for his valuable suggestion being a co-guidefor the first six months of my work.I pay my sincere respect to Dr. M. Sadashiva Rao, principal of Dr. B.R.K.R Govt.Ayurvedic College, Hyderabad for providing facilities for the research work.I am thankful to Dr. L.R.K Murthy, Superintendent, Govt.Ayurvedic Hospital, Erragadda,Hyderabad, for permitting me to conduct research work in the Hospital.I am highly thankful to Dr. V. Anantsayanachari, HOD of P.G. Dept. of S.S.P andDr. M. Philip Anand Kumar, HOD of P.G. Dept. of Dravyaguna for his kindly co-operation.
  7. 7. I cordially acknowledge my friends and colleagues Dr. CH. Sadanandam, Dr. T.P.Sunder Raj, Dr. K.V.N. Raju, Dr. J. Shivanarayana and others who helped me in one wayor other in completing this work.I acknowledge my nephews Dr. Arbind Kumar, Dr. Prasant Kumar Singh and my seniorDr. Raghubansh Mani Singh for their co-operation and suggestions throughout the work.I am thankful to my roommates and friends Dr. Ram Adhar Yadav, Dr. Ram ChandraAdhikari and Dr. Mangalakant Jha for their co-operation and suggestion in completingthis work.I pay homage to my beloved father Late Sri Ram Krit Singh, my beloved Sister LateSmt. Usha Singh and brother-in-law Late Sri Nagendra Singh their incessant love andblessings was constant driving force behind my progress.I bow my head on the feet of my mother, brothers, sisters, sisters-in-law, brothers-in-law,who always stand with me in each and every stressful moments of my life. My love andappreciations to my all nephews and nieces for standing with me all time with loveaffection and patience.I thank to Mr. Murali and Mrs. Sundari for typing this work neatly.I am highly grateful to the authors of all the books and articles which have been utilizedby me as the source of information in the preparation of this thesis.Lastly I am thankful to all my patients of trial drug and all those persons, who have helpedme directly or indirectly for this project work. Dr. BINOD KUMAR SINGHDate:Place: Hyderabad
  8. 8. CONTENTS INTRODUCTION 1-31. HISTORICAL REVIEW 4-8 PART-I LITERARY REVIEW2. CONCEPT OF AGNI 9-233. CONCEPT OF AMA 24-284. DISEASE PROFILE • NIDANA 29-35 • SAMPRAPTI 36-39 • ROOPA 40-49 • SADHYA-ASADHYATA 50-50 • SAPEKSHA NIDANA 51-53 PRINCIPLE OF TREATMENT • CHIKITSA KARMA 54-66 67-69 • PATHYA PATHYA5. DRUG PROFILE 70-86 PART-II CLINICAL STUDY6. MATERIAL AND METHODS 87-897. OBSERVATIONS AND RESULTS 90-1068. DISCUSSION 107-1129. SUMMARY 113-11410. CONCLUSION 115-11611. BIBLIOGRAPHY 117-120 ANNEXURE
  9. 9. INTRODUCTION The growing prevalence of Rheumatological disorder amongst million ofpeople of the world has become a serious health concern. Today over 100 millionurban and rural Indians are seriously suffering from Rheumatological disorder.What’s more alarming is that not only the urban or rural men and women, butnearly 1% children have same problem. Medical experts say that at this rate, Indiawill be facing rheumatological tsunami. Rheumatology, a branch of Internal medicine which deals with musculoskeletal system and connective tissue and with those generalized conditions whichpresent with bone and joint pain. The musculoskeletal disorders are morecrippling and hamper the economy of the individual as well as the world, whichare best known as Rheumatological disorders.CLASSIFICATION OF JOINT DISEASES IN AYURVEDA Joint pain and swelling (saruja sandhi sotha) Inflammatory Non-inflammatoryMono articular Polyarticular Mono articular Polyarticular• Krostuka sheershaka • Amavata • Vata kantaka • Viswachi Spandylo • Vatarakta • Apvahuka arthopathy • Khalli vata • Sandhi vata The word ‘Amavata’, itself explanatory term which indicates ama and vataare the most important factors in aetio pathogenesis of the disease. In Vedic 1
  10. 10. scripture such as Rigveda and Atharvaveda, where ‘Ama’ word interpreted asAma, Amat, Amayat, Amayatam (Rigveda), Amaya, Amayam (Atharvaveda).The Ama has been compared with visha and its role in causing disease describedin Atharva veda. Charaka described ‘Ama’ as disease and causative factor ofmany disease. Charaka has also used the term ‘Amavata’ in sotha chikitsa(Ch.Chi.12/51), Pandu roga chikitsa (Cha.Chi.15) and vatavyadhi chikitsa(Ch.Chi.28) and cardinal sign and symptoms of Amavata has been described inGrahani Chikitsa (Cha.Chi.15). Susruta mentioned term ‘Ama’ reference ofvidradhi chikitsa and Amajeerna in Udara roga but did not use the word‘Amavata’. Vagbhata first time has given detailed description of Ama. He saidmalfunctioning of Agni produced Ama. Madhavakara first described ‘Amavata’as independent disease entity along with its etiology, pathogenesis, sign andsymptoms Prognosis and complication. Chakra datta was first to describe the lineof treatment with many combination the drugs. People are not conscious about their food habits, which disturbing agni andproducing ama. Busy life style i.e., immediate exercise after taking heavy andincompatible food, indulging in fast food, stored food, freezed food may furtherdisturbed the agni and produce ama and increase the vata simultaneously, thisleads to more incidence of Amavata in society, presents alasya, gourava inhridaya, jwara, saruja sandhi sotha, aruchi etc., and make a individual suffering. Clinical research on Amavata has been undertaken at different canters.Some Ayurvedic physician correlated it with Rheumatoid Arthritis and some withRheumatic fever. But Amavata appears to be a group of Rheumatic /inflammatory musculo skeletal disorder on comparison with modern view and itshould be diagnosed and treated on Ayurvedic line only. The disease Amavata belongs to madhyama roga marga according tomanifestations of symptoms (A.H. Su.12/47). But actually the production of the 2
  11. 11. disease or vyadhi samuthana takes place in annavaha srotas or kosta, whichbelongs to abhyantara roga marga. The production of ama and vata (samana)vikriti, vata dosha samurchana takes place in Amashaya and Pakwashaya, hencethe origin of the disease to be of abhyantara roga marga. But the manifestation ofclinical features appears, in the organ belongs to madhyam roga marga. Hence itcan be said that the disease involves both abhyantara and madhyama roga margas. The disease has been considered to be the most painful and greatestcripplier of mankind. It not only affects the joints but also has systemic effectsleading to various cardiovascular, neurological and heamatological manifestation,thus making the disease more complicated. Its incidence is common in ourcountry; most of the poor, rural masses suffer with the disease. Despite profoundadvancement in modern system of medicine, in the cure for the disease is still anenigma.Taking all this account it is thought that there is a great need to study andunderstand ‘Amavata’ in its whole aspects, hence it is initiated me to study in thedisease and treatment. Regarding the treatment of the disease, the modern drug treatment consistsof non-steroid anti-inflammatory drugs (NSAID),Diseases modifying anti-rheumatic drugs (DMRD) and steroids, but all are hazardous to health as theycause many side effects. In Ayurveda, the treatment of the disease quite successfulas it is more etiologically oriented and result producing with no side effect.Therefore, the present study with ‘Ajamodadi yoga with Shallaki’ a compounddrug with luke warm water has been taken for clinical trial. ******* 3
  12. 12. Historical Review HISTORICAL REVIEW Ayurveda is as old as humanity, is originated in India long back in pre-vedic period. Rigveda and Atharva Veda have references on health and diseases.Ayurveda texts like Charaka samhita and Susruta samhita were documented about300 years B.C. The term Ayurveda means ‘Science of life’. It deals elaboratelywith measures for healthful living during the entire span of life and its variousphases. Besides, dealing with principles for maintenance of heath. It also hasdeveloped a wide range of therapeutic measures related to physical, mental, socialand spiritual welfare of human beings. Thus Ayurveda becomes on the oldestsystem of health care dealing with both the preventive and curative aspect of lifein a most comprehensive way. WHO’s concept of health propounded in Modernera bears a close similarities to these principles. References to medicines are found in the earliest works including theVedas. But there has been no reference available about the presence ofAMAVATA during Vedic kala since Vedic scriptures are concerned as the earliestrecorded writings. Which are really the landmarks of their ages related to this disease. For thispurpose the entire period may divided into four parts-1. Vedic kala (Ancient period)2. Samhita kala (Classical period)3. Samgraha kala (Medieval period)4. Adhunika kala (Modern period)VEDIC KALA :( 1500 to 800 B.C) Vedic kala is the period when Aryan compiled four Vedas i.e.1500 to 800B.C1. During this period Ayurveda was perhaps the only system of over all health 4
  13. 13. Historical Reviewcare and medicine, which served the people in such crucial areas as health,sickness and life as whole. There has been no reference available about Amavataduring the vedic kala. But we can get the word ‘Ama’ ‘Amat’, ‘Amayat’,‘Amayatam’ words in Rigveda in Pippledhasaka, Atharva Veda also ‘Amaya’,‘Amayam’ words were mentioned while describing chayapachaya kriya inAmavishakta hetu rogas.The concept of ama,its similaritiy with visha and its rolein causing diseases has described. The word Ama also appears in Paniniunadisootra and Hiranya kshaya Gruhya sootra2. In this connection it is clear thatthe knowledge of ama and its role in causing disease have been established inVedic period. Anyhow the word ‘Amavata’ and disease and its description is nowhere found in Vedic literature.SAMHITA KALA (700B.C. to 500 A.D.) In this period we do not find any description of any types of joint disordersunder the heading of AMAVATA. But as already mentioned the description ofama and diseases caused by ama are available in Bruhatrayee. Charaka describedin Trividha kuksheeyadhyaya of Vimana sthana about production of ama3, itssimilarity with vishagunas and its role in causing the diseases in detail. The wordAmavata is also mentioned in sotha and pandu chikitsa adhyaya in Charakasamhita4 (Ch.Chi. 12/52, Cha.Chi. 16/61-63) and its related cardinal symptoms also has beenelaborated in Grahni Chikitsa 5(Ch.Chi.15), Vata vyadhi chikitsa adhyaya6 (Ch. Chi.28). In this period few diseases characterized by Joints involvement with painand swelling have e been found in vata rakta, sandhigatavata,Krostaka sheershakaetc. The disease vata rakta is found in all samhita. Some symptoms of Amavatasuch as Greeva stambha, Trikagraha, involvement of Janu sandhi were describedunder Nanatmaja vata rogas.7 Bhela samhita also has no description about Amavata but described aboutAma. In Hareeta Samhita, Amavata described in detail providing full chapter, theinvolvement of joint with relation to gastrointestinal disturbance was noticed.8 5
  14. 14. Historical ReviewSAMGRAHA KALA (600 AD to 1600AD) In this period Vagabhata was first author to give a detail description aboutAma. As Vagabhata is first samgrahakara and his period about 600A.D. Hedescribed sama vata in Astanga Hridaya9 also stated that samavata is combinationof ama and vitiated vata. But the sign and symptoms described under this headingare different from Amavata disease, which we understand now. Among the booksavailable of this period with Amavata description of Madhava Nidana seems to beoldest. The author of Madhava Nidana (Rugvinischaya) was the first to describe itas a separate disease entity in his period about 700 A.D. He described it in detailincluding its etiology, pathogenesis,10 sign and symptoms and prognosis.Chakrapani in 11th century in his text Chakradatta for the first time gave the line oftreatment for Amavata along with many combination of drugs11. Various books ofthis period like Yogaratnakara, Bhaisajya ratnawali, sharangadhar Samhita, Gadanigraha also prescribed some more combination of drugs. In Bhavaprakashasamhita also a detail description of Amavata is including the line of treatment12.In addition Bhavamishra described a distinct variety of Amavata caused byPhiranga roga i.e., syphilitic Arthritis and also prescribed a specific therapy drugsfor Phirangajanya amavata the drugs like Rasakarpoora, Chopachinyadi etc13.ADHUNIKA KALA (1600AD onwards) In this kala an attempt has been done to incorporate to the availableknowledge in Ayurveda. Dr.Gananatha Sen has done pioneer work in the field ofre-orientation about concept of diseases and their diagnostic methods. He is of theopinion that all the diseases of the joints with swelling and pains either of acute orchronic onsets, on to be regarded as sandhivata. He further classified into fivetypes in which Rasavata included. Rasavata is new nomenclature, which hesuggested as synonym to Amavata is order to express this fact move clearly, thatthis disease is caused by the Rasa which has been incompletely processed. Thereis present trend to classify the joint lesson into this group 1) Samavata 6
  15. 15. Historical Review2). Niramavata, when the joint lesion associated with inflammatory manifestation(the symptoms of ama) along with the constitutional symptoms fever, anorexia,and indigestion then it is known as Samavata14. In contrast to its when there is painand disability, it is known as niramavata. Recently some work has been done invarious post graduate institute of Indian medicine and it has been observed that onthe basis of clinical manifestation and aetiopathogenesis, Rheumatoid Arthritis oftoday may be include in Amavata. In the present situation, medical scientists areresearching for remedies in Ayurveda for lifestyle related diseases, such asAmavata and other degenerative and psychosomatic disorders where this systemhas special strength. ******* 7
  16. 16. Historical Review REFERENCES1. Science and Philosophy of Indian Medicine – K.N.Udupa- Baidyanathpublication 1978, 1st edition.2. Brijpal Sharma – Amavata and its treatment.3. Charaka Shamhita, Vimana sthana chapter 2.4. Charaka Samhita, Chikitsa Sthana chapter 12.5. Charaka Samhita, Chikitsa Sthana chapter 156. Charaka Samhita, Chikitsa Sthana chapter 287. Charaka Samhita, sootra Sthana chapter 208. Hareeta samhita –Triteeya sthana 21st chapter.9. Astanga Hridya, Nidana sthana chapter 16.10. Madhava Nidana, Amavata Nidana chapter 2511. Chakra Datta by Chakrapanidatta, Amavata chikitsa chapter 2512. Bhavaprakash Madhya Khanda, Chikitsa prakarana, AmavatadhikarahChapter 2613. Bhavaprakash Madhya Khanda, Chikitsa Prakarana, PhirangaroghadhikaraChapter 5914. Gananatha Sen- Saidhantika Nidana part-II. ****** 8
  17. 17. Concept of Agni CONCEPT OF AGNIVedic Concept Agni, the God of fire is son of surya, fire and its relation to sacrifice wasdominating feature of the fire cult in Vedic time. The sacrifice was a rite ofsympathetic magic in which an offering was made to the Gods, the celestialcontroller of mysterious and potent force of nature to the continuance ofconditions favorable to mankind. Agni has no human form (Apurusvidha). Manyof references to Agni in Rigveda may be regarded as metaphorical, such as hisassociation with water, in which sometimes hides, an allusion to the storm, cloudsfrom which the lighting appears to originate (RV II, 9, 2 & 4). Shatpatha Brahmana gives to the three fold nature of Agni a distinctivelyritualistic interpretation and defines it as three sacrificial fires. 1. Gaarhapatya: The domestic fire, the honored guest in every home without whom no sacrifice was effectuate, for agni scarifies and witness of every rite. 2. Ahavaniya: The eastern fire, it is first to be lit and to receive the offering. It is called the womb (seat) of the God and the death one who reverences it, falls away from the world and ascend to the celestial world (Trait. Sam) 3. Dakshina: The Southern fire. It receives the monthly offering to the pitrus and it is also the fire in which the dead are cremated.In same work, Agni is said to have eight forms named. 1. Rudra – The Vedic God of tempest whose characteristics thunder and lightning are represented by their respective epithets. The svetasvatara 9
  18. 18. Concept of Agni Upanishad state that Rudra alone is unaffected by the dissolution of the world (pralaya) at the end of age. 2. Sarva: Archer, the name of one of the eight elemental form of Rudra. The dark haired archer. Both sarva and Bhava are called ‘Lord of Cattle and Men’ (AV IV, 28,1,XI 2) a description that applies to Siva (M.Bh.) 3. Pashupati: Lord of animal, a title of Siva. 4. Ugra: Powerful, mightily, terribe. A natural force which may have good or bad effect. 5. Asani: Thunderbolt i.e., Meteorite, lightning. 6. Bhava: ‘Existence’ becoming, Lord of cattle & men. 7. Mahadeva: The great God, title often applied to Siva. 8. Isana: Ruler, master, lord, from the root is to have power.SYNONYMS OF AGNI:Jataveda : Birth from the fire sticks (aranis), the meaning of Jataveda varies but generally has the sense of all knowing possessing wisdom etc.Pracheta : Observant, atlentive, wiseDhatri : Establisher, arranger, founder, creator, supporterKavi, Kastri, Bhutadi, Suresa : As a wise GodApamgarbha : The child of waterHiranyakrita Hiranyareta Vasuret : As a maker of goldVaiswanara Panchajanya : As a universalSamigarbha Arani suta : As springing from fire sticks. 10
  19. 19. Concept of Agni According to Annambhatta in his nyayabodhini on Tarka samgraha, Agni isone of five mahabhuta known as ‘Tejas’. It is two varities – Nityam and Anityam.Nityam is parmanu rupa and Anityam is kavry rupa. Again anityam is three folds. 1. Sariram - In solar region – Aditya loka 2. Indriyam – In eye – Chakshu 3. Vishaya - Object – this is four folds. a) Bhouma – fire etc. b) Divya – lightning etc. c) Audaryam – The cause of digestive of ingested food (Jatharagni) d) Akarajam – Produce in mine – Gold.AGNI IN AYURVEDA Agni in Ayurveda is reflected in the concept of pitta of the system1. Theterm pitta is derived from the root ‘tap’ to heat or to burn2. This term is seen tohave three meaning viz. ‘Tap aishwarye’, ‘Tap dahe’ and ‘Tap santape3. Tapaishwarye refers to that factor which responsible to make one achieve the eightkinds of benefits, 4 ‘tap dahe’ refers to act of burning of the nutrition consumed5and ‘tap santape’ refers to the generation of heat.6 These references are obtainedfrom the Bhattoji’s siddhanta kamudi. From the point of view of Ayurveda, pittahas been described as Agni (fire), since it performs fire like action i.e., paaka,which refers to pachana (digestion), dahana (burning, combustion or oxidation)including bhinna samghata (splitting); tapana (heat production), parinamana7(conversion), Paravriti8 (Transformation), Prakashana (Illumination), ranjana orvarnakara (coloration) and prabhakara (to cause luster). 11
  20. 20. Concept of Agni In general sense the term ‘Kaya’ or body itself has been equated to Agni9.The word ‘Kaya’ is derived from the root ‘chinchayane’ meaning to collect, thecollection refers to food ‘chiyane annadibhih’. This indicates that kaya takes infood digest, absorbs and utilizes in development of the body. In a word the termKaya means building up of the body with food. Chakrapani states that KayaChikitsa is the Chikitsa of Antaragni10. According to Bhoj “Kayati shabdam karoeeti kayo jatharagni”. The word ‘Kaya’ indicates jatharagni. Therefore the termKaya Chikitsa refers to treatment of the diseases, the origin of which can be tracedto impaired Agni (antaragni, jatharagni). In entity of the disease ‘Amavata’, Ama and vata are the most primefactors. The concept of ama is mainly based on the concept of Agni. Henceagnimandya plays key role in producing Ama. Where the concept of Agni is aphysiological approach, the concept of ama is pathological one. Hence tounderstand ama in a better manner, knowledge of Agni is essential and inevitable. In the skeleton of Dosha-Dhatu-Mala theory the functions of Agni areattributed to pittadosha, since the term pitta derived from ‘Tap santapa’ similar toAgni. Pitta is factor, which regulates all thermodynamic, chemodyanamic(enzymes & hormones) activities in the body. Charaka has recorded marichi ashaving stated that “It is only agni, which is located in pitta that gives rise tobeneficial or adverse consequences in normal and abnormal state of functioningcondition of initiation and normalcy respectively”11. “Agnireva shareerapittantargatah …..” (Cha.Su.12:11) Clarifying the implication of the term“Pittantargatah” used in above context, Chakrapani has observed that this termdoes not mean that the pitta of the body is flaming fire and it only refers to thephenomenon of heat which is associated with fire12. By implication, heat is seento be associated with the function of pitta. The reference made by medina andAmarkosa to the functions of Pitta, here a direct bearing on the paaka karmas ortransformation. The implications of these two aspects of pitta vyapara are the 12
  21. 21. Concept of Agnidigestion of food and its transformation into various functional and structuralfactors of the body. The question if the pitta and Agni are identical or different has been raisedand answered by Susruta in the 21st chapter of Sutra sthana in his samhita.Dalhana clarified that Saadrushya is present in the view of physiology i.e.,qualities and functions but difference is viewed in aspect of chikitsa13. The VijayaRakshita has closed the controversy by quoting Bhoja’s reference14, saying that‘pitta agniyorabhedhakatwa’ is only the sadrusha nirupana, but differencebetween pitta and Agni are several. Hence it is to be concluded that the Agni ortejoamsha is a part of pitta15. It is clear from the class, the concept of Agni, whichrefers to the manifold functions ascribed to pitta, is comprehensive. It not onlyincludes chemical agencies responsible for aharapachana in the kosta(corresponding to gastrointestinal digestion), which leads to separation ofsarabhaga (nutrient fraction) of the ahara from the kittabhaga (Undigested residueof food) but also metabolic events, energy synthesis and maintenance ofmetabolism. In addition, it is seen to comprehend photo and chemo syntheticprocesses pochaka pitta which is responsible for all above activities, is knownvariously as Jatharagni, Kosthagni, Antaragni, Pachakagni, Deanne and Audaryaagni. While being located in its own place in the area between amashaya andpakwashaya16, directly participates in the digestion of food and at the same timelands support to and augments the functions of remaining pittas, present elsewherein the body17. Further it is held that the pachaka pitta contributes moieties of itselfto seven dhatwagni and supports and augments the function of the latter18 It is clear from the classical Ayurvedic texts that the enumeration of thenumber of agnis (which include pitta) varies from author to author. According toCharaka Samhita read together with its main commentary by Chakrapani Datta,the number of agnis enumerated is over 13 as Antaragni 1, Bhutagni 5,Dhatwagni 7 19 13
  22. 22. Concept of Agni On other hand, Susruta is seen to have described only five agnis viz.Pachagni, ranjakagni, alochakagni, sadhakagni and Bhrajakagni20. There ishowever an indirect reference in Sushruta samhita to five bhutagnis, in the briefdescription made to the transformation, which food stuff undergo in theorganism21 when these five agnis are taken into consideration, the total number ofagnis according to Sussruta would be ten. Vagbhata is seen to have reckoned.5 pittas5 bhutagnis7 Dhatwagni3 Doshagni3 Malagni -in all twenty three Agni.22 Of the more recent authorities, Sarangadhara is seen to have recognizedfive pittas only23 on the other hand; Bhavamisra is seen to have followed Charakaand Vagbhata24. However classification of Agni for the purpose of practical utilitycan be made on follows: 1. Physical aspect. 2. Clinical aspect.Physical aspect: 1) Jatharagni-1 2) Bhutagni - 5 : i) Prithvi ii) Ap iii) Tejo iv) Vayu v) Akasha 3) Dhatvagni – 7 : i) Rasa ii) Rakta iii) Mamsa iv) Medo v) Asthi vi) Majja vii) Sukragni 14
  23. 23. Concept of AgniClinical aspect: On the influence of doshas, Agni can be classified into fourvarieties. a) Sama – Under in sama dosa condition (equal equilibrium of doshas) b) Teekshagni – Under influence of pitta doshas. c) Mandagni - Under influence of kapha dosha. d) Vishamagni - Under influence of vata dosha.JATHARAGNI The term ‘Jatharagni’ was shown earlier to be synonyms of pachaka pitta(Agni) the other synonyms of it being kosthagni, antaragni, kayagni and audriyaTejas. The concept of Pachaka pitta (Kosthagni) has been described by the threemain authorities of Ayurveda viz., Charaka, Sushruta and Vagbhata at distinctperiod of time.According to Charaka Kosthagni (Pachaka pitta) is the leader offactors concerned with digestion (and metabolism) in the body of all living beings.The activities of all these factors–normal and abnormal are derived from thedependent upon an increase or decrease, on the case may be of Jatharagni25. Heproceeds to observe that “The seat of agni is in the region above the nabhi(Umbilicus)”26 (Ch.Chi.15:35). The seat of Agni is known as Grahani, because itreceives and retains the food for duration of digestion. The structure grahani issupported by Agni. It retains the food which is still to be digested, while thedigested portion of the food is moved down (to the Pakwashaya) on either side 27 Susruta says – the pitta which is located in an area between amashaya andpakwashaya (Pakwamashaya madhyasthana) is responsible for digestion of fourkinds of food (chaturvidha ahara) ingested by living beings, sarakitta & vibhajanaand leading to production of doshas, rasa, mootra, pureesha in the process.Located as it is own place (Pakwamashaya madhyasthana) it contributes to and 15
  24. 24. Concept of Agniaugment the functions of other locations of pittas, in the performance of actions.This pitta is, therefore, spoken of as Pachakagni28. According to Vagbhata in his Astanga hridaya and Samgraha, the pitta,located between Pakwashaya and amashaya is panchabhoutika and a dravyainspite of which it performs action similar to anala (fire) due to the accession ofthe tejas component over the remaining member of the panchamahabhuta thatcompose it. This fact is inferred from the way in which it performs pakadi karmassuch as the digestion of food and separation of saara from kitta, in addition, whilebeing located in its own place. It contributes to and augments the functions ofother pitas elsewhere in the body.29 In the Chapter “Dosadivijaniya” of hisSamgraha, Vagbhata has stated that a decrease or increase of dhatu, occuraccording to the teekshanata or the mandyata of the aspects of pachakagni, presentin the dhatu.30 “As the flame of a forest fire tends to increase or decrease, according as thequantity (more or less, as the case may be) of Indhana (Fuel) available in itsproximity so also is the case with ‘dhatuparampara’. ‘Dravya are either tulya(homologous) or Vishista (Heterologous) to the dhatu which cause an increase ordecrease, respectively of the dhatus due to properties inherited by and potentiallypresent in them, as in the case of seed, “Homologous properties of dravyas causeda rapid increase of identical qualities or similar properties in the dhatu, whereasdravyas possessing heterologous qualities make for a rapid decrease of the dhatu”.Again in Astanga hridaya, he has summed up the earliar samgraha version quotedabove in the following term; Moieties of kayagni, which located in its own place,are distributed to and permeate through all the dhatu; a decrease of it makes for anincrease of dhatu makes for the decrease of the dhatu.31 In view of given references made to kayagni by Vagbhata in his Samgrahaand Hridaya, in latter work, he relates the pachakagni to dhatwagni carrying a 16
  25. 25. Concept of Agnidirect suggestion that the former contributes moieties of itself of the dhatu32. In thesamgraha, he has directly correlated the pachakagni to dhatwagni and dhatupaka(tissue metabolism) 33. This correlation will be come further amplified by takinginto consideration a few more observation made by Charaka, Susruta andVagbhata. Charaka has made a pointed reference to the madura (sweet) and amla(acid) aspect of digestion in the amashaya, corresponding obviously to the starchand protein digestion in the stomach. This observation assumes significance, in the context of reference made byhim to passage of gastric digest → the acidified chyme→ from the amashaya tothe next succeeding portion of the digestive apparatus, synchronizing with thesecretion, into this place of accha-pitta corresponding to the flow, into theduodenum, of the combined pancreatic juice and the liver bile.34 Again , themention made by Sushruta of the pittadhara kala (or the pitta supporting orsecreting membrane ) as the structure which holds the chyme derived from fourkinds of foods propelled from the amashaya and on its way to the pakwashaya35focuses attention to the location of the agni, the special aspects for the Vagbhata tothe organ Grahani vis a vis pachaka pitta is also equally grahani describes thelatter organ as being responsible for holding organ and identifies the kala (thecovering mucus membrane) here as the agnidhara kala36 . The function of Jatharagni includes digestion of the food, saara kitavibhajana (absorption) are carried out by the enzymes or chemical substances andcertain physical maneuvers like different direction of intestinal movement i.e.physico-chemical process starting from mouth to end of the Gastro-intestinal tract.It may no be proper to attribute the function of the Jatharagni to a particularenzyme or chemical substance in the Gastro intestinal tract. Hence all theparticipants in the physicochemical process of digestion and absorption can besaid as moieties of Jatharagni. However the centralized function of Jatharagni or 17
  26. 26. Concept of Agnimost of the important process of digestion takes place in the middle part of the guti.e. Duodenum which is the site for many neurohumoral complex functions. The main locations of jatharagni are ‘Amapakwashayamadhyama’, Grahaniand Pittadharakala. All these three appears to be performing similar functions areembedded in each another. Pittadharakala is located in Grahani antarbhaga andGrahani located Amapakwashaya madhyamamBHUTAGNI The body is made up food, in the sense, all the elemental factors requiredfor maintenance of growth of the body in depending upon the same received fromexternal atmosphere i.e. food, air, etc. Both the human body and food are derivedfrom the combination of five bhutas37. In a nutshell this panchabhoutika sareera isto be maintained and nourished with the bahya panchabhoutika amshas. Toconvert such alien amshas as part of body there exists a process of paka which isattributed to bhutagni. So all the exogenous substances must be subjected tobhutagni paka to become endogenous.38 Both Charaka and Vagbhata have made direct reference to bhutagni paka,while Sushruta has made a mention of it . The out come of Jatharagnipaka is thebhinnasanghata or the splitting of a complex food substances into their ultimateelemental units or molecules or into five physicochemical groups i.e. parthiva,apya, tejas, vayavya, nabhasa. Jatharagni is stated to ignite the Agni present ineach of groups. The agni moiety present in substance belong to each group is,then stated to digest the substance of the group, leading to a radical change in theirqualities, vyalakshna guna. Thus food substances are rendered fit for beingassimilated into the built up as part of the corresponding bhuta class of substancepresent in the dhatu. According to Sushruta "the animated human organism iscomposed of five mahabhutas and the food of a living organic being, necessarilypartakes the qualities of its corporal components. The food which consists of five 18
  27. 27. Concept of Agnimahabhutas are digested in its turn by the five bhutagnis and each of its principleproceed to augment its own homologue in the human organism.39 Vagbhata in his Sangraha and Hridaya has clearly described the stepsleading to bhutagni paka and in his view; the separation of Sara from kitta takesplace after composition of bhutagnipaka. As the food consumed are foreign to the body i.e. vijateeya and unless theyare suitably processed they may not be converted as specific organism i.e.sajateeya substances. This can be illustrated with the example of starches, fats andproteins or panchabhuta components of food which by the process of digestion arerendered fit for to be resynthesised as organism specific carbohydrate, fat andprotein or panchabhuta components of the body.DHATWAGNI The term ‘Dhatwagni’, refers to agnis or pitta, which take part in pakas ofahar dravyas previously dealt with by five species of bhutagni. Dhatwagnis areseven in number corresponding to seven dhatus. They are Rasagni, Raktagni,Mamsagni, Medogni, Asthyagni, Majjagni and Sukragni. These agnis are stated tomediate or catalyze metabolic transformations of nutrient substances before theyare supplied to the species of dhatus (rasa, rakta, mamsa, medo, asthi, majja andsukra) through their respective or species srotamsi. Charaka has stated that the nutrient substances that support the body, aresubjected to paka again, being acted upon by seven dhatwagni, leading to theformation of two products viz. kitta and prasada40 and his observation that thenutrient substances which nourish the dhatu, undergo paka by the ushma (agni) ofthe dhatus and they are made available to the dhatus through their respectivesrotamsi41. 19
  28. 28. Concept of Agni In the chapter on vividhasitapitiya of sutra sthana of Charaka samhita,Charaka has observed that the wholesome foodstuff ingested in four fold manner,having been digested by antaragni, is fallowed by further pakas, under influence ofbhutagni which latter have been duly ignited by the former agni(jatharagni) whichagain are subjected to further pakas by dhatwagnis. Subjected to the condition thatthe dhatusma (dhatwagni), dhatuvaha srotamsi and maruta, are not impaired anddhatupaka is proceeded with as inexorably as kala (time, which always flowsforward). The dhatwaharas, thus prepared confer upon the organism strength,complexion, happiness, longevity and provide energy to the dhatus. The nutrientsobtained from food sources are the food for the sharira dhatus, as they contributeto the maintenance of the normalcy of the dhatus 42. The seven kinds of dhatwagnis obviously refer to substances which likeenzymes catalyze the synthesis of seven kinds of nutrient substances, required forthe use of seven species of dhatu- each dhatwagni, aiding the conversion ofnutrient substances in to which may called ‘precursor substances’ of the formeddhatus, already present in the body. The primary tissue elements are spoken assthayidhatus (formed dhatus, already present in the body) and poshya dhatu (thesareera dhatu which are to be nourished). The end product of bhutagni pakas areknown as poshaka dravyas , viz. parthiva poshaka dravyas, apya poshaka dravyas,agneya poshaka dravyas, vayavya poshaka dravyas and nabhasa poshaka dravyas.Dhatwagni paka is stated to metabolise the products of bhutagni paka, the specificAgni corresponding to each dhatu acting upon substances present in the former,which possess properties homologous to those of the latter. Thus rasagni is statedto aid in the structural synthesis of the several constituent of the rasa dhatu, likewise the formation of the constituents of rasa dhatu is catelysed by raktagni.Similar is the case of other dhatus. The substance produced in these reactions isknown as asthayi or poshaka dhatu43. Dhatwagni has two aspects 1) Prasada paka2) Kitta paka 44. 20
  29. 29. Concept of Agni The final products arising out of prasada paaka are then transferred and 45transformed to the sareera dhatu through their respective srotamsi . The endproducts of the kitta are various kind of excretions such as sweda, mutra etc. Poshaka dravya + Dhatwagni → Prasada + Kitta Dalhana commenting on dhatu paka, he says that paka is of three aspectsi.e., a) Sthula or sthayi dhatu 2) Mala 3) Sukshmadhatu for nutrition of furtherdhatu. Rasadhatu (Sthayi)Poshaka rasa dhatu + Rasagni Kapha (Mala) Sukshma rasa Similarly, applicable to all remaining dhatus. That these Dhwatwagni pakaare meant to metabolic equilibrium. Rasadi dhatus which may unceasinglyundergo destruction are replaced by dhatwaharas derived from the chaturvidhaahara ingested46. Further Chakrapani says Sareera dhatu which are destroyed bytheir own agnis are replenished or restored by the chaturvidha ahara ingested. It appears that Dhatwagni and vyapara is parallel to the intermediarymetabolism, described by modern physiology and biochemistry. Intermediarymetabolism has been described as “Changes which may take place betweenmovement of entry of a nutrient into the organism and the movement of dischargeof ultimate chemical product into the environment”47. ******* 21
  30. 30. Concept of AgniREFERENCES 1. Agnireve shareere pittantargatah………….., Charaka sootra sthana 12/11 2. Tapa santape Sushruta sootra sthana 21/5 3. Tapa aiswarye... divadi gana (Tapyate) Tapa dahe... eurvadi gana (Tapayati tapayati) Tapa santape ... bhavadi gana (tapati) 4. Tapyate astavidharmanamadikamiti pitta / 5. Taapyati daahati bhuktamaharajatam eeti pittam / 6. Tapati ushmanamutpadayateeti pittam / 7 Paakah parinatou (Medini) 8 Paakah paravriti (Medini) 9. Jatharah praninamagnih kaya etyabhidhiyate / Yastam………………………Kayachikitsakah // Bhoj: Quoted by Siva Dasa sen in his commentary on Charaka sootra sthana 30/28 10. Kayasyantargneschikitsa Kayachikitsa. - Chakrapani datta 11. Charaka, sootra sthana 12/11 12. Chakrapani on Charaka, sootra sthana 12/11 13. Sushruta soortra sthana 21/9 14-15. Quoted in Madhukosha on Madhava Nidana 55/32 16. Astanga Hridaya, sootra sthana 12/11. 17. Astanga Hridaya, sootra sthana 11/34 18. Astanga Hridaya, sootra sthana 11/34 19. Charaka chikitsa sthana 15/38 20. Sushruta sootra sthana 21/10 21. Sushrut sootra sthana 46/526 22. Astanga Hridaya, sootra sthana 12 & sareera 3 23. Sarangadhara samhita, poorva khanda, chapter 5 24. Bhavaprakasha Prathama khanda, sareera sthana chapter 3 25. Charaka chikitsa sthana 15/39 26. Charaka chikitsa sthana 15/35 27. Chakrapani datta commentary on Charaka chikitsa sthana, 15/56-57 22
  31. 31. Concept of Agni28. Sushruta sootra sthana 21/1029. Astanga Hridaya sootra sthana 12/10-12 and Astanga Samgraha 20/530. Astanga Hridaya sootra sthana 9/1, Sushruta sootra sthana 46/52631. Astanga Hridaya sootra sthana 11/3432. Astanga Hridaya sootra sthana 11/3433. Astanga samgraha sootra sthana 19/26-2834. Charaka chikitsa sthana 15/9-10.35. Sushruta sareera 15/9-10.36. Astanga Hridaya sareera sthana 3/49-54.37. Astanga Hridaya sootra sthana 9/1, Sushruta sootra sthana, 46/52638. Charaka chikitsa sthana 15/1339. Sushruta sootra sthana 46/526.40. Charaka chikitsa sthana 15/15.41. Charaka chikitsasthana 8/3942. Charaka sootra sthana 28/343. Chakrapani on Charaka chikitsa sthana 15/16.44. Astanga Hridaya sareera3/64.45. Charaka chikitsa 8/ 3946. Charaka sootra sthana 28/3.47. Bio-chemistry by Abraham White et –al, page 287. Edition 1954. ******* 23
  32. 32. Concept of Ama CONCEPT OF AMA The word Ama is derived from “Aamyate ishat paschyate.”1 (Vachaspatyam)which indicates that “which undergone slight paka.” Paka means “paakascha agnisamyogath kalavisheshah”. The changes occurring in a substance during the time of agni samyoga. Thelack that specific agni interaction result in ama. Further ama word has got meaningof ‘Ishatpakwa’, ‘Asidha’, ‘Pakarahite’, ‘Apakwam’, ‘Vyasthatam’2, ect. Ama word is used in common language to fruit which is un ripen i.e. beforeits usual season of ripening.3 In the above ‘Ishatpakwa’, means that which undergone slight paka, Asidhimeans not attained final form i.e.sidhi, ‘Pakarahite’ that which is not at allundergone paka. ‘Apakwam’ i.e. partially cooked. Finally the word ‘Ama’ can bedefined as a substance which is not involved in the process of paka withoutattaining its final form. The term ama is ordinary parlance also means unripe, uncooked, immatureand undigested. In the context of medicine, however, this term refer to events thatfallow the factors which arise, as a consequence of the impaired functioning ofkayagni. According to Vagbhata “due to the hypo-functioning of ushma (agni), thefirst dhatu viz. the rasa or chyle , is not properly formed . Instead, the annarasaundergoes fermentation and or putrefaction (dusta) being retained in amashaya. Itthis state of rasa which is spoken as Ama4. He makes a reference to otherauthorities, according to whom “the impaired vatadi doshas (vata, pitta and kapha)by the spoilt kodrava5. The obvious implication of these slokas appears to be that,in the absence or due to the inhibition to kayagni, the food ingested is not properlydigested, and the products which arise out of such an impaired digestion i.e., the 24
  33. 33. Concept of Amachyme and chyle, being retained in the amashaya, undergo such changes as yieldtoxic substances. This state is spoken of as Ama. In the sloka of Vagbhata “Dhatumadhyam apachitam”, the adya dhatu hasto be considered as ahara rasa where kayagni dourbalyata is the prime cause of theformation of ama. Chandranandana and Sridasspandita also consider it as ahararasa whenever according to Arundutta, adya dhatu is rasa dhatu. Hemadriconsider it as rasa which is not capable of executing its functions and also notcapable of transforming into Rakta. The undigested food which resulted due to various causes mentioned inCharaka, attains Suktatwa (fermentation) leading to the onset of toxic states6. Susruta further adds “Vrana paakabhave” i.e., Vrana until it gets paripakwastate is called as ama condition temporarily7. Vijayarakshita has cited a number of definitions and descriptions ofAmadosha obviously from the extent or contemporary authorities. 1. The term annajarasa means ‘Ama’. If annarasa is not properly digested formed them the outcome of such a digestion is known as Ama.8 2. The annarasa which is not properly formed in amashaya due to impairment of kayagni is known as Ama.9 3. The undigested annarasa possessing foul-odour and excessive pastiness deprives the body of its nutrition and in consequence, causes sadana, this is known as ‘Ama’.10 4. Some hold the view that, if due to the poor strength of Jatharagni or residue of ahara rasa is still left behind undigested towards the end of digestion it is then known as ama, which is the root cause of all diseases.11 25
  34. 34. Concept of Ama 5. The view that the food which is not properly digested is ama is held by some yet other describes the accumulation of malas in the body as Ama.12 6. There is also view that the first stage or phase of dosha-dushti or dosh- dushya sammurchana is caused as state of Ama dosha, the chayavastha of shata kriyakalas13. In Shabda Kalpadruma one more is added, stating that ‘Ama is the factor iscausation of Shatprakara ajeernas’14. Sarangadhara says “he samyaka pakwa ahararasa is called as ‘rasa’ and the apakwa ahara rasa as ‘ama’15. Vagbhata describes it as a condition in which the tridoshas and saptadhatus, as well as makes become permitted with ama produced in the amashaya.Disease which arise in consequence, are also spoken of as Sama types ofdiseases16. On critical analysis of all these definitions, one can state that “Ama is astage or condition of a substance result in the process of paka on subjecting to theagni, before attaining its final transformation”. Final transformation in the sense,the ingested material to be transformed either to yield energy in the body (fordhatu vyapara) or for synthesis of new tissue (dhatu nirmana) and final eliminationas end products. Once the substance attain the target state i.e., avastha or form orsidhi. It is not called as Ama. Simply it can be said as “Ama is the precursor stateof a substance in transformation”. Ama condition can be formed at any level ofAgni sannikarsha due to its hypo functioning may be at jatharagni, bhootagni anddhatwagni. After going through all the definitions above, three key words; ‘Ama’,‘Amadosha’, and ‘Amavisha’ emerge. Through all three conveys the samemeaning these words are coined for different states of apakwadravyas. Apakwaahara rasa is different from amarasa, which makes the difference between ajeerna 26
  35. 35. Concept of Amaand ama conditions. The apakwa ahara rasa, which is situated in amashaya getssuktatwa after passage of some time, that suktabhava of apakwa ahara rasa iscalled ama. During further course of time the ama interacts with doshas andbecome pathogenic which is knows as ‘amadosha’17. This amadosha on furtherstatic, get more suktatwa thereby attains and acquires ‘visha’ qualities, thus toxiccondition is known as ‘Amavisha’ it may consider as Gara visha18. In the mode ofcausing disorders, clinical features and principles of treatments are also distinctlydifferent for each condition. Hence Ama, Amadosha and Amavisha terms aredistinct, indicating the actual state of Ama. Schematic representation of Etiopathogenesis of Ama.19 Agnidusti Kayagni Bhutagni Dhatwagni AMA SamavasthaA) Kostagata roga Shakhagata roga Maramasti sanhigata roga Amajeerna Medoroga Amavata Vistabdhajeerna Madhumeha Hridroga Vidagdhajeerna Urustambha Pakshaghata Vishuchika Sopha Ardita Alasaka Diseases of Vasti Vilambika including kidney. Chardi, Grahani, Atisara 27
  36. 36. Concept of AmaREFERENCES: 1. Vachaspatyam by Vachasapati Misra. 2. Shabdakalpadruma vol-I, by Raja Radhakanta Deva, Choukhamba sanakrit series, Varanasi 3. Vachaspatyam by Vachasapati Misra. 4. Astanga Hridaya sootra sthana 13/25 5. Astanga Hridaya sootra sthana 13/25 6. Charaka samhita, chikitsa sthana 15/42-44. 7. Vachaspatyam by Vachasapati Misra. 8. Vijayarakshita on Amavata in Madhava Nidana Chapter 25. 9. Vijayarakshita on Amavata in Madhava Nidana Chapter 25. 10. Vijayarakshita on Amavata in Madhava Nidana Chapter 25. 11. Vijayarakshita on Amavata in Madhava Nidana Chapter 25. 12. Vijayarakshita on Amavata in Madhava Nidana Chapter 25. 13. Vijayarakshita on Amavata in Madhava Nidana Chapter 25. 14. Shabdakalpadruma vol-I, by Raja Radhakanta Deva, Choukhamba sanakrit series, Varanasi 15. Sharangadhara samhita, poorva khanda 6/8. 16. Astanga Hridaya sootra sthana 8/11. 17. Vijayarakshita, Madhukosha commentary on Madhava Nidana 25/1-5. 18. Astanga Hridaya sootra sthana 8/4. 19. Prof. Dr. V.V. Subrahmanya Shastri, Essential of Basic Ayurveda Concept. Page -107. ******* 28
  37. 37. Disease Profile NIDANA Amavata, word consists of two words viz., Ama and Vata and “Amenasahitah vatah amavatah” 1. It means, in Amavata, vata is associated which amaso its main two causative factors i.e., Ama and vata are prime in manifestation ofthe disease. Therefore all causes for Amotpatti associated with vata prakopa asmentioned in Ayurvedic classics may be considered as Nidana of Amavata. So,the causes of Amavata can be studied under two headings. 1. INDIRECT OR NON-SPECIFIC CAUSES 2. DIRECT OR SPECIFIC CAUSESINDIRECT OR NON-SPECIFIC CAUSES: These are the causes for Amotpatti and vata prakopa, which intern causesAmavata. 2A) AHARAJA NIDANA Guru ahara (heavy, not easily digestable food) sevana Atisnigdha ahara (Excessively unctuous food) sevana Atiruksha ahara (Excessively ununctous food) sevana Shuska ahara (Excessively dry and dehydrated food) sevana Ati ushna ahara sevana Ati drava ahara (excessively liquid food) sevana Ati sthul ahara (without chewing, not easily digestible food) sevana Atisheetal ahara (Excessively cold and stable food) sevana Dwista ahara (dispersible food) sevana 29
  38. 38. Disease Profile Vishtambhi (causing flatulence of antiperistaltic) ahara sevana Vidahi (Irritant to amasaya) ahara sevana Asuchi ahara (Contaminated food) sevana. Akale (Untimely) in take food or drink Atyambuplutam (soaked in too much of water due to excessive intake of water) Anashana (Abstinence of food) Ajeernakara ahara (Indigestible food) sevana Adhyasana Atibhojana (over eating) Vishamashana (irregular eating habits) Viruddha ahara (Mutually contradictory or Dietic incompatibilities) sevana Asatmyahara sevana (Intake of unsuitable food) Sandusta ahara (Putrid food article) sevana Dustambu, Maddhya atipana (excessively contaminated water & wine intake) Alpa and laghu ahara sevana. 3VIRUDDHA AHARA: Acharya Charaka described eighteen types of viruddha ahara is his samhitasootra sthana 26/86-87. 30
  39. 39. Disease Profile1) Desha viruddha ahara 10) Avastha Viruddha ahara2) Kala viruddha ahara 11) Krama viruddha ahara3) Agni viruddha ahara 12) Parihara viruddha ahara4)Matra Viruddha ahara 13) Upachara viruddha ahara5) Satmya viruddha ahara 14) Paka viruddha ahara6) Vatadi dosha viruddha ahara 15) Samyoga viruddha ahara7) Sanskarac viruddha ahara 16) Hrit viruddha ahara8) Veerya viruddha ahara 17) Sampada viruddha ahara9) Kosta viruddha ahara 18) Vidhi viruddha aharaB) VIHARAJA KARANAS: Vega sandharana 4(suppressing urges) Vyadhi karshnat 5(emaciation due to disease)5 Deshakalativaishamyat6(by faults in place, climate and seasons) Jalabhi ramana7 Shayya8(Excessive sleep) Prajagara9(Excessive evil) 10C) MANASIKA KARANAS: Kama (passion) Shoka (Sorrow) Krodha (anger) Dukkha (grief, unhappiness) Lobha (greed) Mana (Pride, ego, haughtiness) Moha (Confusion) Udvega (anxiety) Eershya (envy) Bhaya (fear) Chinta (Thought, worry) Hree (Bastifulness) 31
  40. 40. Disease ProfileD) ANYA KARANA: Adverse effects of Panchakarma therapy such as 1) Vamana 2) Virechana 3) Vasti including secant swedana.11 Vyadhi karshanat (emaciation due to diseases)12 Krimi doshas13 All these factors effect the agni directly leads to agnimandyata ormandagni, which is the main factor concerned in produce of ama.DIRECT OR SPECIFIC CAUSES:The direct causes for Amavata as per mentioned in Ayurvedic classics.14 1. Viruddha ahara 2. Viruddha chesta 3. Mandagni 4. Nischalatwa 5. Snigdhabhuktavato vyayamam (exercise immediately after snigdha ahara sevana) 6. Diet saturated which kanda sakas. 15VIRUDDHA AHARA: Many aharaja nidanas are mentioned in classics which can be summedunder one heading viruddhahra. So, this makes viruddha ahara is a very importantnidana for many diseases. Acharya Charaka has described eighteen types ofviruddhahra in Charaka Sutra Sthana 26/86-87 causing vitiation of Agni whichleads to production of ama. Although all the three doshas are vitiated by intake ofviruddhahara but involvement of other vata vitiating nidanas causes thepredominance vata when gets accompanied with ama eventually causes Amavata. 32
  41. 41. Disease ProfileVIRUDDHA CHESTA: These are 1) Ajeerne vyayama 2) Ajeerne vyavaya 3) Ajeerne jalaprataranadi etc. (Madhukosh, Ma.Ni.25). These groups of nidanas are referred to theviharaja causes responsible for the samprapti of Amavata. Virudha chestaindicates all those activities of the body which have an adverse effect on thenormal physiology of body. Thus when normal physiology of body disturbed, thevitiation of agni takes place. This vitiated agni leads to the production ama.Viruddha chesta also vitiation of vata. Both factors when combined produceAmavata.MANDAGNI: Some individuals have internal mandagni because of their prakriti suchindividuals, if without considering their agni, indulge in nidanas. Then they aremore prone to be affected from the disease of ama, as ama production takes palcevery quickly in them, so this is the most important factor in production of thedisease, Amavata. Whatever may be other cuases, they should cause mandagnithrough which amavata is the result. It plays a vital role in production of ama andamavata. The cuases leading to mandagni have been already described in thischapter.NISCHALATWA: This word denotes individuals who are lazy and less active by their nature.In such persons continuous consumption of nutritious or even normal diet aids inaccumulation of kapha dominant dhatu. Also due to sedentary habits, agni getsvitiated which in turn leads to vitiation of doshas and production of ama. Hereagain vata dosha if vitiated more due to their nidanas, along with ama catalyzesthe pathogenesis of amavata. 33
  42. 42. Disease ProfileSNIGDHABHUKTAVATO ANNAM VYAYAM… (Exercise immediatelyafter snigdha ahara): It is advised in Swasthavrita to take some rest after meal for the betterdigestion and to keep the doshas in same position. Snigdhahara which is also guruin nature if proper rest is not taken after that ahara and doing exercise,immediately, vitiates the vata dosha (samana vata) which in turn disturbs thepachakagni. Then it will not able to digest the ingested ahara, which may resultinto ama leading to amavata. Whereas vyayama just after snighdahara cuasesvitiation of vayu and also khavaigunya in sandhi due to excessive mobilization ofsandhis. Thus vyayama acts as Khavaigunya producing nidana and combinationof it with snigdha ahara sevana makes a specific nidana for Amavata.Diet saturated with kanda shakas: This cause is mentioned by Hareeta Samhita only. Naturally kanda shakasconsists of more guru, snigdha gunas and madhura rasa, which becomes heavy forJatharagni, and those may play a role in causing the disease assrotoabhishyandakara. But, over all these causes comes under the causes leading to Mandagni.After all while summing up that all the causes mentioned above will lead forproduction of ama and vitiates the vata, which in turn produces the diseaseAmavata. 34
  43. 43. Disease ProfileREFERNCES: 1. Shabdakalpadruma part. I, Raja Radhakanta Deva, Choukhamba Sanskrit Series, Varanasi. 2 Charaka samhita vimana sthana 2/8 Charaka samhita chikitsa sthana 15/42 Charaka samhita chikitsa sthana 15/67 Sushruta samhita uttar tantra 40/3-5 3. Charaka samhita sootra sthana 26/86-87 4. Sushruta samhita sootra sthana 46/500 5. Charaka chikitsa sthana 15/43-44. 6. Charaka chikitsa sthana 15/43-44. 7. .Sushruta samhita uttar tantra 40/3-5. 8. Charaka samhita vimana sthana 2/9 9. Charaka samhita vimana sthana 2/9 10. Charaka samhita vimana sthana 2/8-9. 11. Charaka samhita chikitsa sthana 15/43-44. 12. Charaka samhita chikitsa sthana 15/43-44. 13. Sushruta samhita uttar tantra 40/3-5 14. Maddhava Nidana Amavata nidana chapter 25. 15. Hareeta samhita sootra sthana chapter 21. ******* 35
  44. 44. Disease Profile SAMPRAPTI Vayuna prerito hyamah sleshmasthanam pradhavati | Tena-atyartham vidagdhojasou dhamanih pratipadyate|| Vata-pitta-kaphairbhuyo dusitah soannajo rasah | Srotamsya-abhisyandayati nanavarno-atipichhilah || Janayatashu daurbalyam gauravam hridayasya cha | Vyadhinama-asrayo hyesam Ama-sangyo atidarunah || Yugapat-kupitavantas triksandhi pravesakou | Stabdham cha kuruto gatram Amavata sa uchyate || (M.Ni.25/2-6)1Sleshmasthanam: The shleshmasthana is considered as panchavidha sleshmasthana i.e., hridaya, amashaya, sandhis, sirah and jihwa. In the present context, Hridaya and Asthi sandhi are to be considered as inthe Samprapti of Amavata.Dhamani: Arterial system throughout the body..Vatapitta kaphairbhuyo dushitah so annajorasa: Again amarasa is associatedwith tridoshas.Srotasya abhishyandyati: It obstructs the all srotas of the body.Nanavarna: Discolouration of bodily external secretions due to ama like stool,urine etc.Atipischila: Sticky quality of Ama.Ashu dourbalyam: Development of acute general debility.Gouravam hridya: Heaviness in the chest. 36
  45. 45. Disease ProfileTrika sandhi: As Madhavakara mentioned the manifestation of the disease startfrom Trika sandhi. The word trika means a joint of three substances.“Trayonaamsangah kah trikam.”2 Parishadyam ( subdartha saareeram). Apart from bones,togetherness of three parts also called as trika. Sushruta describes two trikasandhis where on Dalhana comments on it as Urdhwa trika nd adhaha trika.Urdhwa trika means a sandhi pradesha of both shoulder and vakksha 3. Dalhanasays Sandhana sthana of shira and bahudwayam (Trikam shiro bahudwayasandhana sthanam)4. While commenting on Susruta 21 chapter. Again Susrutadescribes the trika as khandabhaga of sroni 5(Yaddapi sronikanda bhage trikamprasiddham)5. In Amara Kosha, Trika is described as “Pristavamshadaretrikam”. In relation to the site of manifestation of Amavata. It appears that thelowest portion of vertebral column i.e., trikaasthi sandhi may be consider as trikasandhi. Practically it is seen that the manifestation of the disease start from all thebigger joints. Hence trika sandhi mentioned by Madhavakara is to be consider asall the bigger joints i.e., Wrist, elbow, shoulder, hip, knee, ankle, iliosacral jointsetc. The production of ama takes place due to factors mentioned in nidana. Theama rasa is carried to sleshma sthanas i.e., hridaya gata avalambaka sthana,sandhigata sleshmaka sthana by vitiated vata. Ama travels to shleshma sthanabecause it is giving to its own gunas (Snigdhadi). In sleshma sthana ama againgets paka (vidagdha) or vitiation by prakopita vata. After vitiation by vata itenters into circulation through dhamani. Now the amarasa circulated, spreads allover the body and to all organ by arterial circulation. As the amarasa to becirculated through Dhamani and gets in the Hridaya. It also gets tiredness due tothe circulation of heavy materials (apakwa ahararasa) which is having guru,snigdha and other indigestible molecule. Again the proper hridaya dhatu (cardiactissue) is also deprived of its nutrition as circulated rasa dhatu is not fit fordhatwagni vyapara. As a result at this stage the symptom ‘Gouravam hridyasya’ is 37
  46. 46. Disease Profilenoted. Until this stage, there is no manifestation of any specific clinical feature,but ‘Asudourabalyam’ and ‘Hridyagouravam’ may be treated as Poorva roopa ofthe disease. Again that amarasa is vitiated by vata pitta and kapha then the amarasacauses sroto abhisyandakaras and nanavarna atipichchila i.e., due to srotoavarodha all bahya srotas secret abnormal colored secretions. The different typesof colour of urine in prameha and various coloured of stool in Amatisara etc areseen, these are considered as nanavarna in ama conditions. The amarasa willbecome further too vicid, which is able to causes sroto avarodha and the disease,wherever srotodusti is there, there it will stick due to abhishyanda karaguna and itcauses of so many diseases. As the rasa in apakwastha, the function of rasa dhatu i.e., preenana karma,will get lost, by that all dhatu in the body will get starvation of its nutrition as aresult “ashudourbalyam” takes place. Instead of ‘Ashudourbalaym’,Bhavaprakashakara described ‘Janyatyagni dourbalyam’ as first manifestation.Here, Agni dourbalyam suggests the jatharagni and dhatwagni dourbalyam. Asthe heavy apakwa ahara rasa circulated to the dhatu. The dhatwagni may getdourbalyam due to their in efficacy to digest it. Due to this, Agni dourbalyam theama condition further aggravates, which leads to the further production of Ama. Mandagni produces ama, ama produces mandagni. It is having a link ofmutual contribution, which helps each other in a cycle for continuation of thedisease process. The ama being pischilatwa guna and snigdhadi guans, would naturallyshows its affinity to the kapha sthana, it is how the joints effected by Amavata.The gunas or physico chemical qualities of ama in the circulation enhances thekaphadosha, which leads to kapha prakopa. As already vata is in prakopa avastha.Both prakupita doshas immediately attack or enter the trika sandhi formanifestation of the disease “Amavata”. 38
  47. 47. Disease ProfileREFERENCES:1. Madhava Nidana, Chapter 25/2-6.2. Trayonaamsagah kah trikam. / Damodara Sharma Goud – Parishadyamsareeam, 2nd Edition 1979, Baidyanatha Publication.3. Sushruta Samhita chikitsa sthana chater 4/18.4. Trikam siro bahudwaya sandhana sthanam.. / Dalahana.5. Sushruta sareera sthana 5/16. ******* 39
  48. 48. Disease Profile ROOPA The roopa of Amavata as described by Madhavakara either samanya orpravriddha is appeared in all the texts which described Amavata without anyaddition exept few authers.SAMANYA ROOPA: Angamardoaruchitrishna haalasyam gouravam jwarah | Apaakah shoontaanganaam Amavatasya lakshanam || Ma. Ni. 25/6Angamarda: The word ‘Angamarda’ is made up of Anga + marda. Anga meansAvayava (organs), gaatra (body) (Vachaspatyam) and Mardana means pain. In the disease ‘Amavata’, all the circulating Ama molecules in the body arepossessing abhisyandi, Pischila, guru etc., ama gunas hence they are unable toeither cross the cell membrane or metabolised. So it becomes exogenous, causingirritation at every part of contact, by which the vata at the site will not have freemovement inturn leading to prakopa at every point of contact in the tissue throughout the body. The vata prakopa all over the body gives rise to painful conditionsknown as angmarda. Apart from this due to guru guna circulating ama becomesheavy to the bhootagni as well as for rasagni also, hence leading to agnimandyataat these level thereby producing more mala, which inturn enhances sroto avarodhaand causing vata prakopa resulting acute body pain i.e., Anga marda.Aruchi: Aruchi means arochaka, ashraddha, anabhilasha. “Na anne ruchirbhavati” (Shabdakalpadruma) 40
  49. 49. Disease ProfileMeans no interest to take food. It is one of the important lakshana of amacondition which is more predominant in Amavata. Since the ama accumulatesmore at sleshma sthanas. Jihwa or rasendriyagata bodhaka sleshma gets vitiationand loses its function of rasabodhana hence aruchi is noticed. Apart from this, asthe malas are in circulation Jihwapalepa (coating of tongue) is the prominent sign.This coating of malas in taste buds interrupts the perception process by srotoavarodha leading to aruchi.Trishna:Trishna means “Peetam peetam hi jalam shoshaytastavato na yaati shama” (Ch.Chi.22/7) It is also known as udanya, pipasa, Trit, Tarsha, Trisha etc. This symptomappears because of the circulating fluid viscosity has been increased due to amagunas, hence to maintain normal viscosity, pH value and homeostatic. The bodycraves for more fluid and stimulates the thirst center in the brain. And due to amasroto avarodha in udakavaha srotas which leads to Trishna.Alasya: “Yah saamarthye apyanutsaaha sthadalasya mudeeryate” (Sarangadhara Samhita Purva Khanda 6/67) Means the person who has not zeal or enthusiasm to do any work but he hasability. It is also known as Tandra, mandata, Karyapradwesham (Ra.Ni.). So in caseof Amavata, the nutrition is deprived to the tissue due to ama hence the indiryasare not able to perform its function. This condition known as Alasya. Whenviscosity of the blood increases the cerebral vascular blood flow decreases, whichleads to incapability of brain function (anutsaha) thereby alasya. 41
  50. 50. Disease ProfileJwara: “Dehendriya manastaapee sarvarogaagrajo bali” (Ch.Chi.3/4) Where the body temperature is higher than normal, manas and indrias arenot in the normal state to percept their subjects, is called Jwara. This lakshana orsymptoms is commonest appearing in all acute amavata cases, where virulence ofsookshma amarasa is more. Sookshma ama rasa enters into rasvaha srotas andobstruct or plugs the swedavaha srotas (rudhwa swetambu vahinisrota) therebycore temperature of the body raises above normal, which we call Jwara. Apart from this, when ama is in circulation body raises the temperature andkeeps it enhanced unless until the ama gets pachana in the body as defensemechanism. Thus raise of temperature becomes an inevitable indication forpresence of ama.Apakah: “Paakaabhava apakah” (vachaspatyam) Means Ajeernata (indigestion). As we know amavata is based on Ama, theproduct due to hypofunction of Agni (Mandagni) so in this stage, the ingested foodparticles can not be properly digested, and causes apakah or Ajeerna.Shoonitaanganam: The word ‘Shoonatanganaam’ means inflammation redness, tenderness andswelling over the joints. “Karoti sarujam shotham yatra doshah prapadyate”Whenever the doshas move that swelling also move. Each in acute amavataconditions, few joints swell and give rise to vrischika vyavida vedana. Butdisappears on its own, in one day and next morning, another joint gets effected andprevious joints get relieved. This condition of migratory (Bhramanasheelatva) 42
  51. 51. Disease Profiletype, which is almost all pratyatmaka linga of amavata, which is key todifferentiate with condtions of vatarakta and sandhivata. This pathologicalcondition appears due to sudden pouring of synovial secretion into the joints i.e.,increased sleshaka sleshma due to ama and getting regression.PRAVRIDDHA ROOPA: Sa kastah sarvaroganam yada prakupito bhavet Hasta-pada-shiro-gulfa-Trika – Janooroosandhishu|| Karoti sarujam shotham yatra doshah prapadhyate| Sa desho rujyate atyartham vyaviddha eva vruschikaih|| Janayet so agni dourbalyam Prasekaruchi gouravam|| Utsaha-hani vairasyam daham cha babumootratam|| Kukshou kathintam shoolam tatha nidraviparyayam| Trut-chardi-bhrama-moorchascha hridgraham vidvidbddhtam| Jadyantrakooja-anaham kastas cha nyanupdravan|| (Ma.Ni.25:7-10)Hasta-pada –Shiro-gulfa-Trika-Janu-uru-Sandhi sotha Saruja; “Shavateeti shotha” means shopha, svayathu, utsedha i.e., swelling and rujameans roga (disease), Peedo (Pain). In case of amavata, it affects all the joints,whenever sleshaka sleshma is present, the dosha moves the sleshma sthana i.e.,joints and effect them produce pain. The joint of hand or hasta snadhi (PIP, MCP,Wrist, elbow and shoulder joint), Pada sandhi (Metatarso phalengial, Distalenterphalangeal), Shiro sandhi or the joints of cervical region, Gulfa sandhi orankle joints, Trika or Sacroilliac joint janu sandhi or knee joints, uru sandhi or hipjoints are involved in amavata and indicating that it effects all synovial joints(sleshaka sleshma sthana). But mostly the movable joints are effected in thedisease, why because the sandhis are sleshma sthana and ama comes to sleshma 43
  52. 52. Disease Profilesthana which causes swelling of the joints by the guna of ama andprakopittasleshaka sleshma obstruct the srotomarga of vata which inturn getsprakopa causes severe pain i.e., sandhi ruja.Vrischika damsa vedana: Vrischika damsa vyavida i.e., pain is a peculiar type of symptoms inamavata. The pain which is a localized burning type of pain particularly inspecific area wherever vrischika damsha takes palce. That pain is throbbing andcutting type and which has nature of upward spreading. This is the nature ofvrischika vyavidavedana (A.H.U.37/6-7). Similarly in case of amavata, wherever theama accumulates in particular joints, it causes swelling of the joints leading totension, pain, and prakuta vata at this site also causes pain as it is obstructed there.The swelling and pain moves from one joint to another joint as the dosha movesfrom one place to another place.Agni dourbalayam: The manifestation of agni dourbalyam is result of mutual contributionmechanism of amotpatti and mandagni. Mandagni produce ama, which in turnincrease the kapha dosha causes mandagni to become still manda. Again due toMandagni ama production takes place continuously. Hence in Samprapti of thedisease, it is a continuous cycle which keeps the continuity of the disease process.Praseka: Prasechanamiti means chyuti Kaphajanya laladi srave (Cha.Sa..8)As we know, in regarding samprapti of the disease, the ama reaches all thesleshma sthana through circulation, vitiate the sleshma so kantha pradesha is alsobodhaka sleshma sthana (Chakrapani ) due to bodhaka sleshma prakopa, praseka i.e.,hyper salvation is noticed. 44
  53. 53. Disease ProfileGourava: “Sareera Gouravadasya shila Gatrair vichurnita” (Shabdakalpadruma) Means Gurorbhava i.e., Gurutwam or heaviness of the body. The feeling ofheaviness in the body is the result of guru guna present in ama. When ama rasa isin circulation it causes, less oxidation, less physical activity, less cerebral bloodflow, which slows down the function of the organ leading to feeling of heavinessin the body.Utsah-hani: This word ‘Utsahani’ made up of utsaha + hani. “Karyarambhesu samrambhah stheyaanutasaaha uchyate” (sabdakalpadruma) The person who gave ardor to do something is called utsaha i.e.,enthusiasm and the loss of the enthusiasm is called ‘Utsaha hani’. This symptomis seen in amavata due to vitiation of kapha. Charaka has also cited Bhadrakapyaas saying that kapha, in its normal state confers the utsaha. Apart from this herealso less oxidation, less physical activity, less blood circulation in brain whichslow down the function of organs and leading to utsahahani also along withgouravam.Vairasyam: “Mukha virasataayam” Means disperception of rasa or taste. Here also due to vitiation of bodhakakapha and jihwa is not able to percept taste, lead to mukhavairasyata. Apart fromthis due to agni mandyata excess ama produces which coats the jihwa. So, the tastebud is not able to percept the taste of food material which leads to vairasyam.Daaham: “Sarvanga santape daha” (S.K.D.) 45
  54. 54. Disease Profile When the ama rasa enters into rasavaha srotas it manifests the jwara asmentioned in Jwara Samprapti. Hence the jwaravega in severe condition theprakuptia pitta will cause the symptoms such as Daha.Bahumootrata: Bahumootrta means the condition where a patient possess a large quantityof urine i.e., polyuria, when ama is more in circulation, the body tries to take it offeither by way of sweda or mootra but due to ama, Sweda avarodha takes place, sothe sole excretion of mals is to be made through rune only resulting inbahumootrata. Due to increased viscosity of blood in entravascular compartment,fluid of other compartment rushes to circulation due to osmosis, thereby increasevolume in circulation lead to bahumootrata.Kukshi kathinyata: Kukshi – Udara (Vaidak Shabda sindhu), Jathara, kosta. “Kukshih pichando jatharam tundam syadudaram cha tat” ) (Vachaspatyam Kukshi kathinyata means rigidly, stiffness, due to Abhisyandhi,tantumyakta, pischila guna of ama at the Jathara, they stik to the mucosalmembrane of colon, will not permit the puresha to move downward freely andperistaltic movement will also hamper hence srota avarodha take place in thecolon and leading to rigidity i.e., Kukshi kathinyata.Kukshi Shoola: “Kukshishoola eeti khyato vatadama samudbhavah” (Su.Utt. 42/125)When the ama vitiates vata in the koshta (GI Tract), produced shoola (pain) iscalled kukshi shoola. Hence this symptom also may be seen in Amavata diseasewhy because it has also root cause ama and vitiated vata. 46
  55. 55. Disease ProfileNidraviparyayam: Due to severe pain, shoontaanganam, vrischika damsa vedana, sandhisotha and ruja and prakuptia vata, the patient will not get sleep. Apart from this,in acute condition, the mobility during the day and the increase condtiion of amacauses vata prakopa leading to sleeplessness during night and in the whole night asthe movement are not made ama increases and more kapha vridhi which inturninduce sleep (nidra) in the day. This change of cycle of sleep known asNidrapiparyaya.Chardi: “Chhodayanna nanam vegairardayannanga bhanjanaih Niroochyate chardireeti dosho vakram pradhavitah” (Su.Utt. 49) Due to ama, the srota avarodha takes place in annavahasrota and vitiatesvata which causes the reverse peristalsis of the stomach and evacuation of itscontents through the oesophagus and mouth, result to chardi i.e., vomiting.Bhrama – Moorcha:Bhrama: “Chakravad bhramato gatram bhoomou patati sarvada” (Ma.Ni.) Loss of balance where the patient feels that everything is rushing roundhim. This is also called vertigo, giddiness and dizziness.Moorcha: “Moorchamohosamuch chhrayayoh” (Shabda kalpa druma) Means to lose consciousness for a short of time also known as faint. In theamavata Bhrama and Moorcha may be seen, when the jwararoga severe theprakupita pitta will be also caused for Bhrama & Moorcha.Hritgraham: The word hridghraha is made up of hrid +graha, Hrid denotes the hridaya(Heart) and the word ‘graha’ derived from Grah + Bhave ap means roga or vedanain particular organ (S.K.D.). Therefore Hridgraha is consider as Hridaya roga (Heart 47
  56. 56. Disease ProfileDisease). In case of Amavata, the manifestation of the disease takes place in allthe sleshma sthanas so here hridaya is also noted as Avalambaka gata sleshmasthana. Apart from this when the amarasa becomes too vicid by vata pitta andkapha in the circulation causes srotoabhisyandakara, Pischilata. Due to these gunasthe amarasa obstructs the hridayagata srotas; it gets widespread inflammation suchas Pericarditis, Myocarditis and Endocarditis. The Pericarditis occurs during theacute phase of the illness and is an important cause of pericardial effusion.Myocarditis is important during the acute phase of illness and if severe causescardiac failure and death and Endocarditis may lead to valve deformities whereMitral valve stenosis is the common result in Amavata. Aortic valve may alsodamaged by Endocarditis. These Mitral and Aortic valves diseases subjected tomuch greater pressures in their srotas due to avarodha. Tachycardia also has beenseen in the case of Amavata. Hence Hridgraha may be also manifested due toAma.Vidvibaddhtam: Vidvibaddhatam means difficulty in passing faeces i.e constipation.Vidbiddhatam is one of the commonest symptom in Amavata, appears to be resultof vata prakopa. Apart from this, due to abhisyandi, bahoopischila and tantumayagunas of ama in the kostha, will not permit the pureesha to move down freely dueto stikness to mucousal membrane or the kostha (colon). The peristaltic movementis also disturbed due to vata prakopa so the patient suffers with difficulty inpassing faeces i.e. constipation, it is known as Vidvibaddhatam.Jadyaantrakunjanam Due to vata prakopa and Ama in the kostha, the intestinal peristalsismovement may be disturbed and malasanga will take place, which may lead toJadyaantrakunjana.Anaha :a) “Aa samantaat nahayate badhyate avaroodhyate vaa malasya vaayoscha maargoyasnima roge sa anaha” (Madukosha) 48
  57. 57. Disease Profile b) “Mootrapureeshsha rodhakam rogah” (Sabdakalpadruma) A complete obstruction of mootra pureesha along with vata in the kostha iscalled Anaha. The symptom also may be presented in the Amavata because theaccumulation ama and malas in the kostha causes vitiation of vata (Apana vata),which may lead to obstruct the mala in the kostha. Other symptoms such asabdominal discomfort or fullness and flatulence may be associated withconstipations. ******* 49
  58. 58. Disease Profile SHADHYA-ASADHYATA The Sadhya-ashadhyata of Amavata, described by Madhavakara is based onthe doshanubandha lakshanas. “Pittatsadaharagam cha sashoolam pavananugam / Stimitam gurumkandoom cha kaphadustam tamadishet //” (Ma.Ni.25/11)Vata anubandha lakshana: If vata is predominant in the disease, it will cause more shoola in the jointsand some time may be in kukshi.Pitta anubandha lakshana: If pitta is predominant, it causes daha all over the body and specially at thejoint involved along with raga i.e., burning sensation and redness.Kaphanubandha lakshana: If kapha is predominant, stimitata (Aadracharmanaddhavat prakriti),Gurutva (heaviness) and kandu (iching sensation) will appear prominently thanother symptoms. Hence Madhavakara considered the sadhyata asadhyata as “Ekdoshanugah sadhyo dwidosho yapya uchchayate| Sarvadehacharah shothaha sah krichchrah sannipatikah”|| (M.Ni.25/12) Ek doshanuga – 1) Vata 2) Pitta and Kaphaja ama vata are to be considered asSadhyavastha. Dwidoshanuga i.e., vatapitta, vatakapha and pittakapha amavata are to beconsidered as krichchhra sadhya. The sannipataja amavata along with sotha throughout the body is to beconsidered as Asadhya roga. Apart from this, as we discussed earlier, Amavatabelongs to Abhyantara and madhyama rogamarga, hence the Amavata is said to beKriccha sadhya.UPADRAWAS: If the upadrawas such as sankocha, khanjatwadi follows thedisease, it will treated as ashadhya. If any organic involvement or damage presentin the disease it can be said as ashadhya. 50
  59. 59. Disease Profile SAPEKSHA NIDANA The disease Amavata is easy to be diagnosed because it is having specificetiology, clinical features and it appears to be specific disease entity. Eventhough, it may be obviously fair to diagnose when full clinical features appeared,but it may lead to confusion when all the signs and symptoms have not appeared.Hence it is essential to differentiate with other diseases, which manifests speciallyin joints similar to Amavata and other general diseases which may manifests in thejoints as symptom of it. According to available literature the disease whichmanifests the joints are vata rakta, sandhivata, krostaka sheersha, hence theamavata may needs to be differentiated with these.VATA RAKTA: The differentiation between vatarakta and Amavata may be done in threeaspect 1) Nidana 2) Samprapti 3) Lakshanas. The factors which cause the raktavidahyata and vata prakopa are in general and specifically atimarga gamana, ridingon camels, elephants etc., which are not at all factors in the pathogenesis ofAmavata. In Samprapti, the disease spreads and manifests in rakta dhatu, whereasAmavata spreads to sleshma sthana. Main dooshyas in Vatarakta are rakta, medoand masma dhatus where as Rasadhatu in amavata. Vata rakta starts frompadanguli spreads all over the body where as later manifests all over the body andshows it features in many sites at a time. In aspect of clinical features, thevascular and dermatological manifestations are nil in Amavata. As we are mostlyconcerned with the effects of the joint.KROSTUKA SHEERSHA: Krostuka Shreesha described under vata vyadhis, but is the result ofprakupita vata and dooshita rakta, similar to vata rakta. It manifests only in kneejoints as a result joint takes shape of jackal’s head. We can obviously differentiate 51

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