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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.......

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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  • 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. “Namami Dhanvantarimadi Devam, Surasurairvandit Padapadmam | Loke Jararugbhay Mrutyunasham,Datarmisham Vividhoushadhinam ||”
  • 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. 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. 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. 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. 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
  • 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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
  • 60. Disease ProfileAmavata with the disease-because Amavata is a systemic disease its causativefactors are ama and vata and it affects all the joints in the body.SANDHI VATA: Sandhivata is a disease manifested by prakupita vata dosha in the sandhis.Its clinical features are 1) Loss of function of the joint. 2) Swelling of the joints3) Pain on movement 4) Joint appears as leather bag filled with air. Amavatashows other (general) symptoms apart from Joint disorders. Amavata is caused byama and vata. It is a systemic disease and manifests in all joint whereas sandhivata manifests in chala sandhi and weight bearing joint. The detail differentiationshown in table. Amavata Vatarakta Sandhivata Krostuka seershaEtiological Amajanya ahara, Vata, Rakta Vataprakopa Vataprakopa,factors - guru, virudha ahara prakopa kara ahara, RaktaAhara ahara, matsya Malnutrition vidahikara Madhya, ushna, ahara teekshna, guru aharaVihara Exercise after meal Ushna, Gaja More physical No specific sedentary life, less yana, more exertion more cause exercise, unhygienic vehicle driving walking, conditions running, weight lifting, weight bearing work, heavy body weight.Age Childhood, Middle age 25-50 Middle age to Middle age 35- adolescence more years old age above 40 years predominance of 40 years acute cases between 4-25 years sub acute - middle age group 25- 35 years, chronic cases 35-45 yrs.Sex More in females Equal in both Both sexes Common in sexes bothSeason More common in Grishma ritu, All season No specific varsharitu Sharda rituSocio- Low and middle socio- Middle, or high More in low and No related.economic economic conditions, class middle classescondition slum dwellers, middle class. 52
  • 61. Disease Profile Amavata Vatarakta Sandhivata Krostuka seershaSandhigata Snigdha, drava Rooksha, ragayukta Rookshavata, Snigdha ragaappearance poorna driti poornadrithi, no krostuta (jackle) change in colour sheershavataHridaya Involved No involved No involved No involvedSandhigata No changes Hasta pada sandhi, Asthi dhatu Sandhi pakaorganical vakragati, ligaments kshayachanges and joint changesJwara +++ ++ Rare +Appetite Poor No change No change No changeGatra Present - - -stabdhataBahumootrata ++ Dahayukta mootrata No change No changeNidra ++ No change No change No changeviparyayasStarting from Trika shandi (long Paadamoola, Sandhi Janu sandhi bone joints) karamoolaNature of All over the body Start from lower limbs, - -starting spreads to upper limbs.Nature of Bhramanasheela Prasaranasheela Fixed Fixedspreading (Migratory) spreading typeSkin No involvement +++ Rooka -involvementMalabaddhata Present - - -Other clinical Angamarda, Trichina, Advised Neurological -features Vrischikavyabida karshyatvasparsha, manifestation vedana Ajnanatwa, may present Dermatological, Severe constant Pain on vascular manifestation. pain movementCommon Involvement of heart, Ajanu sphutitha, twaka Restricted or Vranavat paaka,complication vascular changes, sphutana, prabhinna locking of joint joint locking. pandu, sotha, MSK prasutam, Balakshaya, movement, deformities on Mamsa kshaya. orthrosis involvement of rakta and pitta (similar to vata ratka) osteoarthiritis on involvement of vata- dosha (as a Sandhivata).Upashaya Increases with sneha Improvement with Maximum relief Relief with lepa sweda, relief with sneha sweda pinda with sneha sweda and bandhana. pradeha and rooksha sweda. karma sweda. ******* 53
  • 62. Disease Profile CHIKITSA KARMA The diseases caused by Amadoshas are described by the Apatarpanachikitsa1.Vagbhata classified the state of ama into three types and indicatedseparate treatments. Langhana-Upavasa treatment is indicated in alpa (mild) state of ama. Langhana and Pachana drugs are indicated in where ama is in madhyama(moderate) state and sodhana kriya is indicated in prabhuta (excessive) state of ama2. The principle of treatment of Amavata consists of langhana, swedana, tikta katuausadhas ahara, deepana, virechana, snehapana, vasti, kashaya vasti, anuvasana vasti andruksha sweda with valuka putaka and sneha vivarjita upanaha sweda locally for theeffective part.3Langhana chikitsa in Amavata In amadosha, medicine should not be given in acute stage because the agniis already in dourbalyavastha in such condition it will not be able to digest thedoshas, amarasa and aushadha, at same time, it may further detoriate and kill theperson4. Hence we should not give any medicine or ahara in acute stage of ama.According to Chakrapani, in condition of ama dosha anasana roopa langhana hasbeen advised5. The abstinence from ahara, give a sort of relief from agni by notputting an additional load on it. By that agni rejuvenates its capacity and slowly ittries to digest the ama which is held before it. The langhana karma causes laghavakarma in the body and removes the gurutva, jadyata, stabdhata, gurugatram causedby Ama. The ama dosha is also disease, which is to be treated by langhanam.6Apart from this the langhana karma is specific in the conditions where ama rasa(sookshma) entered in the circulation 7. 54
  • 63. Disease Profile As the amavata is a condition caused by ama and vata, the role oflanghana karma is restricted to some extend if langhana karma is continuedbeyond the ama pachana, it immediately causes vata prakopa by virtue of itsqualities and effects. Hence the karma should be done upto a extent where samacondition comes to an end. According to the experiments conducted on fasting rats at the center forcellular and molecular Biology, Hyderabad, the belief is scientifically true.Intestinal cells absorb more from the reserve food available in the body duringstarvation8 (upvasa). Reserved food is stored in the body either as glycogen or fats. Glycogen, apolymer of glucose is stored in the liver and during non-availability of food certainenzymes break it down into glucose, which provide energy to the body. Themembrane cholesterol level goes down and therefore the membrane becomes freeand absorbs more during fasting and the nutrient absorbing cells become moreefficient. In proceeding of national academy of science, U.S.A., an Austrian groupheaded by Dr.Grasi-Kraupp has proved the “Restriction of dietary calories reducescancer formation is animal and probably also in human fasting has an exhibitoryeffect on cell proliferation.9 Experiment on the intestine have also shown similar results during fasting(uparasa) since proliferation is affected, the lining cells arrange themselves in suchaway that surface area for absorption of digestive food is increased by 20% to30%. By fasting one converses a lot of energy, which would be utilized for theother function of the body. This proves that fasting is beneficial if done it the rightway.10 55
  • 64. Disease Profile The naturopathy is also applied upavasa (fasting) as a eliminative therapyto flush out the endogenous toxins from the body by liver and kidney. Theendogenous toxins are nothing these all are consider as Amavisha. Fasting does not impose a solution on the disturbed working of the body,but allows it space and time, a period of physiological rest’ during which healingcan occur naturally. In acute conditions, most notably fevers and infections, it should be firstchoice of health care, since fasting dramatically increase of immune function, atleast for the first 24 to 36 hours.11 In chronic conditions, such as heart disease, rheumatoid arthritis, ulcerativecolitis, psoriasis and eczema, there is huge amount of evidence showing thatcontrolled and supervised fasting can help such stubborn and sometimes life-threating conditions to clear completely12. In 1991, for example, the prestigious medical journal ‘The lancer’published the result of one-year study of patients with rheumatoid arthiritis whohad been treated by means of fasting and vegetarian diet13. The result of fasting patients with rheumatoid arthritis where so good thatthere can now be no doubt at all that fasting should be the treatment of choice forthe condition and for almost all auto-immune conditions in which, the body’sdefense systems attack parts of itself. That few rheumatologist employ fasting fortheir patients is indicative of both the lack of awareness of such studies by mostdoctors and the power of the pervading idea that we have to ‘take something’ toassuage symptoms, or to control pain and disability14. Fasting involves commitment, acceptance of responsibility for getting well,and a dedicated sense of purpose.15 56
  • 65. Disease Profile Evidence is also presented to explain an unexpected bonus from fasting-theincreased production of growth hormone (HGH) by the pituitary gland which helpto retard the ageing process.16 For most people, fasting can be a revitalizing experience, restoring energyand clear mind, as well as helping to remove a host of minor symptoms, whileencouraging the self-healing mechanisms of the body to regenerate and rebuild alevel of well being you have probably all but forgotten.17 The benefits of fasting in the treatment of diabetes were first revealed inresearch conducted by Dr.G.Guelpa in 1910, and in 1915 Dr.F.Allen showed thatfasting could normalize the blood sugar levels of a diabetic, as well as improveassociated gangrene. Since then studies into this particular therapeutic potential offasting have continued.18 Clinical trials showing now patients with epilepsy can be helped by fastingcontrolled fasting was found to reduce the length, severity, and number ofseizures19. A great deal of research has verified the value of fasting in thetreatment of heart disease and high blood pressure. In the 1960s and 1970s a hostof reports appeared in the medical press on how fasting had been shown to reducethe undesirable fats in the blood stream, to lower high blood pressure, to reducecholesterol levels, to bring about improvement in cases of atheroma and toalleviate congestive heart failure20. The use of fasting as a treatment for acute pancreatitis was compared withthe standard medical treatment for this condition (nasogastric suction andcemetidine) in clinical study conducted in 1984 involving 88 patients.21 Chemical toxicity has been successfully treated using fasting. For example,when toxic cooking oil containing the rice oil contaminant PCB was consumed, 57
  • 66. Disease Profilepatients were reported to have relief from their symptoms, sometimes dramaticallyso, after between seven and ten days of fasting.22 Patients with those conditions known as auto-immune diseases, whichinclude lupus, ankylosing spondylitis, rheumatoid arthritis, glamerulonephritis(kidney disease) amongst others, have shown marked benefits when fasting hasbeen used in their treatment23.SWEDA KARMA: Sweda karma is an important chikitsa upakrama as relieving or in gettingshamana of vatakapha doshas24, which are the main prakupita doshas in Amavata.Sweda karma relieves the sroto abhisyanda karatwam and the doshas, which are animportant factor in Samprapti Vighatana of the disease. This karma is alsoindicated by Charaka in ama conditions25. It removes the sroto avarodha by itspenetrating action and brings the avarodha doshas to its normal conditions. Inamavata rooksha sweda is most useful in vilayana of the ama and kapha withoutimproving gunas. More over virtue of ushnatva it causes shaman of both vata andkapha doshas and augments its moieties present in Agnis (especially dhatwagni)by which digest the ama (at dhatwagni level). Most of the symptoms of Amavatamay be treated by Swedakarma since symptoms are manifested by ama, vata andkapha. Sweda karma mainly relieves the gurugatrata, stabdhata , sandhivedana,sotha and malavibaddhata etc.TIKTA KATU RASA: Tikta, katu rasa pradhanya dravyas are very useful in treatment of Amavatabecause both are agni deepana dravyas. Katu rasa removes the sroto avarodhacauses ruchi, gets shamana of sleshma dosha and causes laghutwa in the body.Tikta rasa mianly causes agni deepana, ama pachana and it is ruchya. It is lekhana 58
  • 67. Disease Profilewhich is essential in removing the srotoabhisyanda and it is also vishagna whichcounter acts the qualities of Amavisha.DEEPANA-PACHANA: The role of deepana26 and pachana27 dravyas is most important in treatmentof amavata. As mandagni is the sole causative factor in causing the disease. Anydrug, which causes deeptagni, will prevent the production of amarasa. Thepachana dravyas will get pachana of existing amarasa. Both deepana and pachanadravyas will prevent the production of amarasa and gets digestion of existing amain kosta respectively. Both dravyas play a vital role in the treatment of Amavata.These are agneya hence these will improve the agni and gets the pachana of amaas well as gets shamana of vata due to its agneyatwam. If ama present in thekosta, the virechana and deepana karma, if ama spreads all over body langhanaand pachana karmas are advisable28.VIRECHANA KARMA: The Virechana karma mainly indicated for expulsion of pittadosha. But theapplication of virechana karma in amavata is in different view. The amarasawhich stagnated in annavaha srotas is the root cause of the disease, Amavata. Allthe manifestations of Amavata are the result of ama present in annavaha srotas.Virechana karma is the only way by which we can eliminate the koshta sthita amadosha from the body. Hence if we remove the substances or ama which is inkoshta is to be excreted first, to arrest the progress of the disease. Virechanakarma prevents the absorption of sookshma amarasa into the body and preventsfurther manifestation of the disease by expulsing the existing ama in the koshta.SNEHA KARMA: The word ‘Sneha’ is used by Bhaishajya Ratnawalikara and Bhava-prakashakara immediately after the word ‘Virechana’ indicates that the virechana 59
  • 68. Disease Profiledravyas to be used in amavata should be of a sneha in nature, to bring the vata toits normal conditions along with the expulsion of ama. For this purpose Erand tailis specified by most of the texts29.VASTI KARMA: As the prakupita vata is an important causative factor in causing Amavata,to control it and to bring it into normal condition, Vasti karma also indicated.30Here Vasti karma is to be treated as niruha vasti. Bhaisajya Ratnakara preferskashaya vasti aiming on spontaneous effect on both ama and vata at the same time.Hareeta strictly prohibits that no snehakaryas to be done in treatment ofAmavata.31 Vatanulomana and shamana dravyas are also to be sued in Amavata as theapanavata and samanavata are plays the key role in the samprapti of the disease.32 According to Charaka, the treatment of prameha and medovriddhi will beuseful in the disease Amavata33. Rooksha sweda by valuka putaka prescribed by Bhavaprakashakara is playsan important role in relieving the symptoms as follows- - It relieves the srotopratibandhaktwa by getting villayana of kapha and ama. - It keeps the passage free from the movement of doshas by which the vedana is relieved. - It improves the local circulation by which the locally accumulated fluid will be carried out. - It gives a soothing and pain relieving effect at the part effected. 60
  • 69. Disease Profile Apart from the general line of treatment mentioned above, we shouldconcentrate on the treatment of doshas prevalent in the disease. Keeping thegeneral treatment in view, we should add necessity dravyas or upakramasaccording to predominance of doshas. The treatment of Amavata should consisting of the drugs having mainlytikta, katurasas, katuvipaka, ushna veerya and possessing rechana, deepana,pachana actions. Some of the drugs which possess the above qualities are asfollows – Rasna, Chitraka, Erand, Shunti etc. An ideal compound drug to treat the amavata should also consists theproperties mentioned above. In view of above discussions the treatment of Amavata can be summed upas follows:1. Nidana parivarana: Avoidance of causative factors which leads tomandagni, for prevention of further production of ama. This is to be done bylanghana (anasana) karma in relation to ahara.2. Samprapti vighantana: This includes sroto vivrutatwa to enable to doshas toget free movements and shamana of prakupita doshas i.e., vata and kapha. Thisrole mainly played by sweda karma.3. Sodhana karma: - Expulsion of ama present in kosta to prevent the absorption of amarasa (sookshma) and to arrest the further manifestation of the disease. The virechana karma fulfills these principles. - As vata dosha is having predominant role in the manifestation of Amavata, it should be treated with vasti karma. 61
  • 70. Disease Profile 4. Deepana pachana: Deepana of Jatharagni and Dhatwagnis and the pachana of existing koshta sthita and sareeragata ama rasa are to be achieved by deepana and pachana dravyas. As they are agneya dravyas they causes shaman of vatakapha doshas and keeps the samana vata in its position. 5. Dravyas: The drug consisting of mainly tikta, katurasas, katu vipaka and ushna veerya and possessing rechana, deepana and pachana karmas are advisable. 6. Local treat: Rooksha sweda (valuka putaka) is essential to remove sroto- pratibandhakatwa, to get shamana of prakupita doshas, vilayana of ama, and relieves stabdata, guruta, shotha and vedana of the part.THERAPEUTICS: The following drugs are indicated in the treatment of Amavata. Thoughthere are several compound drugs (yogas) prescribed in various texts,.Guggulu preparations: - Yogaraja guggulu Mahayogaraja guggulu - Simhanada guggulu Trayodashanga guggulu - Rasna guggulu Vatari guggulu - Shiva guggulu Vyadhishardul guggulu - Navaka guggulu Amrita guggulu - Swarna mahayogaraj guggulu (R.T.S) 62
  • 71. Disease ProfileRasa preparations - Amavatari ras Amavatari vati - Amavateshwar Ras Vatagajendra ras - Ama pramathani ras Amavatari vajra ras - Amrut manjari ras Swarna bhoopati ras - Vata ganjankusha rasChurna rpeparations- Nagara churna Ajamodadi churna Trivrut churna- Shatpushpadham churna Hingwadham churna Vaishwanara churna- Alambushadham churna Amrutadi churna Devadarvyadi churna- Chitrakadi churna Punarnawadi churna Abhyagadham churna- Pathyadham churna Lavanabhaskar churna Panchasama churna- Asitakadi churna Sunthi dhanyaka churna Bhallatakadi churnaKwatha preparations:- Erandyadi kwatha Sakyadi kwatha Rasnadi kwatha- Rasoonadi kwatha Rasna saptaka kwatha Rasnadasmoola kwatha- Maharasnadi kwatha Suntyadi kwatha Gandharvahastadi kwatha- Panchakol kwatha Dhanya panchaka kwatha 63
  • 72. Disease ProfileTaila / ghrita preparations:Eranda taila Prasarani taila Vijay bhairava tailSaindhwadi taila Mahasaindhwadha tail Dwipanchamooladha tailKanjikadh ghrita Sringaberadham ghrita Sunti ghritaLepa:Shatapushpadi lepaAhinsradi lepaOthers:Rasona pinda Rasonasura Bahusal gudaShobhagya sunti paka Satyadi kala Erandbeeja payasaKhand suntyavaleha Prasarani leha Ajmodadi vatiAmagajasimha modaka 64
  • 73. Disease ProfileREFERENCES. 1. Charaka samhita vimana sthana 2/13. Asataga Hridaya Sootra sthana 8/20. 2. Asataga Hridaya Sootra sthana 8/21-22. 3. Chakradatta Amavata chikitsa Bhaisajya ratnawali Chapter 29/11. Bhavaprakasha Amavata chikitsa. 4. Charaka samhita vimana sthana 3/13. 5. Langhanam anashanam. 6 Asataga Hridaya Sootra sthana 14/11 7 Chraka chikitsa sthana 15/75. 8,9,10 Research Methodology for Ayurvedic scholar by Dr. S.Suresh Babu, Choukhamba orientalia, Varanasi Edition 2001. 11-12. Principles of Fasting, by Leon Chaitow, page 4. 13, 14, 15 Principles of Fasting, by Leon Chaitow, page 5. 16-17 Principles of Fasting, by Leon Chaitow, page 16. 18. Vessby, al ‘Improved Metabolic control after supplemented fasting in Diabetic type 2 patients’, Acta med scand 216:67-74, 1984. 19. Lennox, W. and Cobb,s ‘ Studies in Epilepsy’, Archives of Neurology and Psychiatry’, 20:711-779, 1928 20. Gresham, G., Arthrosclerosis, 23: 379-391, 1975. Duncan, G. et al ‘ Contraindications of therapeutic results of fasting in obese patients’, Annals N.Y. Academy of sciences, 131: 632-636, 1975. 21. Principles of Fasting, by Leon Chaitow, page 14. 22. Imamura, M. et al ‘ A Trial of fasting cure for PCB poisoned patients in Taiwan’, American journal of Industrial medicine, 5: 147-153, 1984. 65
  • 74. Disease Profile23. Brod, J. et. al ‘ Influence of fasting on the Immunological reactions and Course of acute glomerulonephritis, Lancet I : 760-763, 1958. 24 Charaka samhita sootra sthana 143 25. Charaka samhita sootra sthana 14/23-24 26. ” Deepanagni bhumistha……..deeoaneeyam vahnaruddeepanam heetam” Gangadhara 27. Sarangadhara Prathama Khanda chaptr 8. 28. Charaka chikitsa sthana 15/75. 29. Sivadasa sen, in Tatwa chandrika. 30. Bhaisajya Ratnawali, Chapter 29. 31. Hareeta samhita triteeya sthana. 32. Charaka chikitsa sthana 28/298. 33. Charaka chikitsa sthana 28193 ******* 66
  • 75. Disease Profile PATHYA-APATHYAPATHYA The term ‘Pathyam’ means that which is compatible to health. In acutecondition of the Amavata, langhana or anasana is only the pathya, as the conditionof agni and amapachana improves the dietetics mentioned below to be followedaccording to condition of the individual. Hareeta says the pathya regime of jwararoga is applicable to amavata1. After relieving from amadosha, the patient shouldfollows the samsarjana karma, and should follow the ahara vidhi vishesha ayatanaaccording to his individual convenience.2. Katu, tikta ahara dravyas, deepana dravyas, Abdot panna Sali, kulatha,Jangala mamsa rasa lavaka mamsa, and takram are described on pathyas3.Ahara Ch. Ha. B.P. Bh.R. Y.R. C.D. V.Y.Ch.Panchakola paneeya + + + + + +Sigru + + +Tikta phala + + + +Vartaka + + +Vastuka sakam + + + +Punarnava + + + +Patola + + + +Gokshura + + +Karavellakam + + + +Yava + +Purana shastika shali + + + +Lavaka mamsa + + +Takram + + + + +Kulatha yusha + + + + +Jangala mamsa rasa + + + + +Lasuna + + + +Satapushpa +Soubeeram + + + +Gomootra + +ViharaLanghana + + + + +Ahara vidhi vishesha + 67
  • 76. Disease Profile APATHYA In list of apathyas, nidaanokta ahara viharas to be considered as apathyasahara viharas. Apart from Amavata nidana, the factors which lead to mandagniare also to be considered as apathyakaras. Generally all abhishyandakara, guru, pischila guna dravyas, asatmya aharasVeganirodha, Jagarana, Adhyasana, vishamashana, anoopa mamsa sevana areapathyas for Amavata patient4. Bathing with cold water, drinking the cold water isadvisable to avoid5Ahara M.N. Ha. B.P. B.R. Y.R. C.D V.Y.C.Dadhi + + + + +Matsya + + + + +Guda + + + + +Ksheera + + + + +Mashapista + + + +Anoopa mamsa + + +Taila +Ushna dravam +Dwidala danyam +Upadika + + +ViharasSheetal vayu sevana +Sheetal jala snana +Sheetal jala sevana +Ajeerne vyayama +Ajeerna vyavaya +Ajeerne jalaprata +Vyayama after snigdha +aharaJagarana + + + +Veganirodha + + + +Vishamashana + + + + 68
  • 77. Disease ProfileREFERENCES: 1. Hareeta samhita 3/21 2. Charaka vimana sthana 2/14. 3. Bhaisajya ratnawali 29/234. 4. Bhavaprakasha amavata chikitsa 8/129. Bhaishjya ratnawali 29/236 5. Hareeta samhita 3. 21/47 ******* 69
  • 78. Drug Profile DRUG PROFILE Preparation taken for trail “Ajamodadi yoga with shallaki”1. AJAMODADI CHURNAAjamoda vidangani saindhava devadaru cha //Chitrakah pippalimoolam shatapuspa cha pippali //Maricham cheti karshansham pratyekam careers budhah //Karshastu panchapathyaya dasha syurvridhadarukat /Nagara cha dashiva syuh sarvanyekatra churnyetn //Piveta koshna jalenaiva churna swathunashanam /Amavatam ruj hanti sandhipidam cha Gridhrasim //Katipristhagudastam cha janghayoshosha cha rujam jayet / Sharandhara Samhita churnaprakaran 6115-1192. SHALLAKIKunduru madurstiktastikshnah twachyah katurharet /Jwaroswedagrahalakshmimukharoga kapha nilaam // (Bhavaprakasha)Kunduruh katustikto vatasleshmayapahah / (Dhanavantari Nighantu)Detailed description of drug is individually as follows:I. Ajmodadi yoga with Shallaki: Consists of • Ajamoda 1 part • Shatapuspa 1 part • Vidaga 1 part • Maricha 1 part • Saindhava 1 part • Pippali 1 part • Devadaru 1 part • Hareetaki 5 parts • Chitraka 1 part • Vriddhadaruka 10 parts • Pippalimoola 1 part • Sunti 10 parts • Shallaki (kunduru) 34 parts 70
  • 79. Drug Profile AJAMODASanskrit Name : AjamodaLatin name : Carum roxburghianumFamily : UmbelliferaeSynonyms : Karaavi, kharaasva, Brahma kusha, Dipyaka, Bastameda, urgragandha, Hastimayuraka, Valli, GandhadalaVernacular names : Hindi – Ajmoda; English – Celery fruit ; Telugu- Ajmoda, Vamu or Tella vamu; Bengali – Randhuni; Marathi &Gujarati – Ajmoda, Tamil – AsmatavomamPart used : FruitsProperties : Rasa – Katu, Guna - Laghu, ruksha, tikshna Veerya - Ushna Vipaka – KatuKarma : Kaphavata shamaka, AgnideepanaIndication : Hikka-adhyamana, aruchi, krimihara, shoola, chardi, vastiruk, hridya uttejaka, Vrushya, balya.Major chemical : Anthoxanthins, graveobioside A & B, luteolin,constituents papoose glycosider; myristicic acid, aprumetin, umbelliferene, chrysoeriol. Essential oil – d-limonene, d-selinene, spequirterpene, aleohals, abigravin, sedanolide and sedanomic acid anhydride.Dosage : Powder 1-3gms.Vishishta yoga : Ajmodadi churna, Ajmodadi vataka, Hingwastaka churna, Ajmodaraka. 71
  • 80. Drug Profile VIDANGASanskrit Name : VidangaLatin name : Embelia ribesFamily : MyrsinaceaeSynonyms : Krimighna, Chitratandula, Amogha, Vella, Kairali, Tandula, Jantuhantri, Gahvara.Vernacular names : Hindi – Vaividanga ; English – Babreng ; Telugu- Vayu vindagalu ; Bengali – Vidanga; Marathi –&Gujarati – Bavidanga, Tamil – vilanga; Malayalam - VijhalaPart used : FruitsProperties : Rasa – Katu, kashaya; Guna – Laghu, Ruksha, tikshna Veerya - Ushna Vipaka – KatuKarma : Vishghna, krimihara, deepana.Indication : Krimiroga, udara roga, adhmana, shoola, kushtaMajor chemical : Embelin, christembine, homoembelin,constituents homorapanone, vilangine, quercitol etc.Dosage : Powder 3-5gms (for worm infection 5-10gms)Vishishta yoga : Vidangadi loha, Ajmodadi churna, Vidanga rist, Vidanga tail, vidangarist, Trimadasara. 72
  • 81. Drug Profile SAINDHAVA LAVANASanskrit Name : SandhavahLatin name : Sodii chloridumSynonyms : Saindhava, sheetashiva, lavanottama, sindhu lavagna, pathya, shivatmaja, manibandha.Vernacular names : Hindi – Saindha namak ; English – Sodium chloride ; Telugu- Saindhava lavanam ; Bengali – Saindhava lavana ; Marathi – Sidholoon; Gujarati – Sindhalun,Properties : Rasa – Lavana, Madhura; Guna - Laghu, snighda, seta, sookshma Veerya - Anushna Vipaka – MadhuraKarma : Uttama Tridoshagna, Deepanam, Pachana, Ruchyam Vrushyam, Himam, netryam, Hridya, Avidahi, Lavanottama.Indication : Krimiroga, udara roga, adhmana, shoola, kushtaVishishta yoga : Bhaskara lavana, Saindhavadhya taila, Ajmodadi churna, Vaishwanara churna, Hingwastaka churna, panchaskar churna, Sankha vati, Agnitundi vati. 73
  • 82. Drug Profile DEVADARUSanskrit Name : DevadaruLatin name : Cedrus deodaraFamily : PinaceaeSynonyms : Indra daru, Drukilinam, Bhadradaru, surobhuruha, Amaradaru, Surahva, Bhadradri, Surakashta, KilimamVernacular names : Hindi – Devadara ; English – Himalayan cedar ; Telugu- Devadaru ; Bengali – Devadaru ; Marathi &Gujarati – Devadar, Tamil – Devadaru.Part used : Bark, heartwood, oil, leaves, resin.Properties : Rasa – Tikta, Katu, kashaya; Guna - Ruksha, laghu Veerya - Ushna Vipaka – KatuKarma : Kapha-vata hara, deepana, kasaharaIndication : Kasa, swasa, hikka, adhmana, jwara, krimi, kandu, kusta, sopha, vyanga, prameha, pinasa, dustavrana.Major chemical : Essential oil from wood, P-Methylacetophenone,constituents atlantone, Sesquiterpenes (α & β- himochalene, himachalol etc.), stem bark, deodarin, toxifolin.Dosage : Powder: 3-6gms; Tail: 10-40dps.Vishishta yoga : Devadarvyadhi kashaya, Ajmodadi churna, Devadaryadi taila, Devadaryadi churna.Research : Stem bark extract showed significant anti- inflammatory activity in rat. (Ind. J. Pharmacol. 5:334-1973) 74
  • 83. Drug Profile CHITRAKA MOOLASanskrit Name : Chitrak moolamLatin name : Plumbago zeylancia linnFamily : PlumbaginaceaeSynonyms : Anala, Dahana, vahnisanjnaka, Agni, Agnika, jyoti, Neerdahana, vahini, such, hutasana.Vernacular names : Hindi –Cheeta, Chitra, Chitraka; English – Leadwort; Telugu- Chitramulamu ; Bengali – Chita; Marathi – Chitramul ; Gujarati – Chitro, Tamil – ChittiriPart used : Moola, twak (root bark)Properties : Rasa – Katu; Guna - Laghu, Ruksha, ushna, teekshna Veerya - Ushna Vipaka – KatuKarma : Vatakaphahara, deepana, pachana, Grahi, RasayanaIndication : Shoola, Arshas, Grahani, Udara, krimi, Pandu, KasaMajor chemical : Chitranone, plumbagin, 3-chloroplumbagin,constituents droserone, Elliptinone, isozeylinone, Isozeylan- one, Zeylanone and zeylinone, maritone, plumbagic acid, digydrosterone, β-sitosterol etc.Dosage : Powder 1-2gmsVishishta yoga : Chitraka hareetaki, chitrakadi vati, Ajmodadi churna, chitraka ghreeta, chitrakadi leha, chitraka rasayana, saddharana yoga. 75
  • 84. Drug Profile SATAPUSHPASanskrit Name : SatapushpaLatin name : Anethum sowa kurz.Family : UmbelliferaeSynonyms : Atilambi, Karavi, Madhura, SitachatraVernacular names : Hindi – Soya ; English – Dill seeds; Telugu- Sadapa vittulu ; Bengali – Saluka; Marathi – Sepu ; Gujarati – Suva.Part used : Fruit, leavesProperties : Rasa – Katu, Tikta ; Guna - Laghu, teekshna Veerya - Ushna Vipaka – KatuKarma : Vatakaphahara, deepanaIndication : Shoola, Jwara, netra roga, vrana, Gulma, Adhmana, yonisula etc.Major chemical : Fruit or seed oil – Carvone, dihydrocarvone,constituents limonene, apiol, dill-apiol, α-berga-motene, transdihydracarvone, β-caryophyllene, cugenol, cis-ocimene, diffuran, β-sitosterol.Dosage : Powder 1-2gms; Oil : 1-3 dps; Arka 20-40ml.Vishishta yoga : Shatapuspadi kasaya, Shatapuspadi lepa, Satavari kalpa, Ajmodadi churna, arka soya. 76
  • 85. Drug Profile PIPPALI / PIPPALI MOOLASanskrit Name : Pippali/Pippali moolamLatin name : Piper longum linn.Family : PiperaceaeSynonyms : Kana, Krishna, kola, chapala, tikshna, tandula, magadhi, vaidehi, ushana, soundi.Vernacular names : Hindi – Peepal; English – Long pepper; Telugu- Pippallu ; Bengali – Pipul; Marathi – Pipali ; Tamil – Tippili; Malayalam – TippaliPart used : Fruit & rootProperties : Rasa – Katu; Guna - Laghu, snigdha, teekshna Veerya - Ushna Vipaka – MadhuraKarma : Vatakaphahara, deepana, vrishya, rasayanaIndication : Udara, Phiranga, jwara, Kusta, prameha, gulma, arsa, sula, amavata.Major chemical : Essential oil, mono and sesquiterpenes,constituents caryophyllene, piperine, piplartine, piperlongumine, piperlonguminine, pipernonaline, piperundecalidine, pipercide, sesamin, β-sitosterol etc.Dosage : Powder ½ - 1gmsVishishta yoga : Pippalyadi ghrita, pipplyasava, vyoshadi vati, yakrit plihari loha, yakrit pippali yoga, Ajmodadi churna, chousata prahara pippali, Pipplyadi leha. 77
  • 86. Drug Profile MARICHASanskrit Name : MarichaLatin name : Piper nigrum linn.Family : PiperaceaeSynonyms : Ushna, Krishna, Dhanavantari, Dharmapatana, Vellaja, sakanga.Vernacular names : Hindi – Kali mirchi; English – Black pepper; Telugu- Miriyalu ; Bengali – Golmaricha; Marathi – Mirin ; Gujarati – Kalamari, Malayalam – Nalla muluku; Tamil – MilaguPart used : Fruit.Properties : Rasa – Katu; Guna - Laghu, teekshna Veerya - Ushna Vipaka – KatuKarma : Vatakaphahara, avrishya, deepana, pramathi.Indication : Pinasa, kasa, pravahika, hierogram, krimi, swasa, sula.Major chemical : Piperene, piperethine, piperolein A&B, feruperine,constituents dihydroferuperine, citronellol, cryptone, dihydrocarveol, α&βpinene,piperonal, camphene, β-caryophyllene β-alanine, pipecolic acid, carotene, ascorbic acid, pipercide etc.Dosage : Powder 0.5 – 1 gm.Vishishta yoga : Ajmodadi churna, agnitundi vati, Mahamarichyadi tail, marichyadi tail, tekraja maricha, marichyadi churna. 78
  • 87. Drug Profile HAREETAKISanskrit Name : HareetakiLatin name : Terminalia chebulaFamily : CombretaceaeSynonyms : Amrita, Abhaya, Kayastha, Pathya, Vayastha, Vijaya, Siva, Jaya, Haimavati..Vernacular names : Hindi – Harad English – Chebulic myrobalan; Telugu- Karakkaya ; Bengali – Haritaki ; Marathi – Harada ; Gujarati – Harad, Malayalam – Kadukkai.Part used : Fruit.Properties : Rasa – Pancharasa (except lavana), Kashaya mainly. Guna - Laghu, Ruksha Veerya - Ushna Vipaka – MadhuraKarma : Tridoshahara, Anulomana, Rasayana, Prajasthapana, Chakshusya, Hridya, Lekhana.Indication : Sopha, Prameha, Kushta, Vrana, Chardi, Vatarakta, Mutra krichchra, Netra roga, Krimi, Hridroga, Asmari, Klaibya, Kasa, Swasa etc.Major chemical : Fruit – anthraquinone glycoside, chebulinic acid,constituents tannic acid, terchebin, Vit.C, Fruit Kernel – Irachidic, Behenic, Lindeic, Oleic, Palmitic and stearic acids. Flowers – Chebulin.Dosage : Powder 3-6gms.Vishishta yoga : Abhayarista, Kamsa hareetaki, Pathyadi kwatha, Triphala churna, Ajmodadi churna, Triphala ghrita, chitraka Hareetaki, Gomutra Hareetaki, Vaiswanara churna, Haritakileha, Agastya hareetaki.Note: It is specifically contra-indicated for pregnant, weak person, dehydrated patients lock-jaw. 79
  • 88. Drug Profile SUNTISanskrit Name : SuntiLatin name : Zingiber officinale .Family : ZingiberaceaeSynonyms : Nagara, sringavera,Viswa, visvabhesaja, katubhadra, mahousadha.Vernacular names : Hindi – sonth; English – Ginger; Telugu- Allaem, sunthi ; Bengali – sont,. Marathi – suntee ; Gujarati –sunt, Malayalam – chukka; Tamil – cukku.Part used : Scrapped and dried rhizome.Properties : Rasa – Katu; Guna - Laghu,ruksha, tikshna Veerya - Ushna Vipaka –MadhuraKarma : Vatakaphahara, deepana, bhedanaIndication : Sula, Amavata, Adhamana, Raktapitta, Atisara, Slipada, Kasa, swasa, Hridroha, sopha, vivandha, Pandu, Vrana, Jvara, Kusta, Agnimandya etc.Major chemical : α-curcumene, β-D-curcumene, β-bourbornene,constituents dborneal, citral, d-camphene, citronellol, geraniol, gingerol, α&β-zingiberenes, zingiberol, zingerone, gingerols, paradol, gingeronone A, ginger glycolipids A,B& C, gingerdiol, gingerone B&C ect.Dosage : Powder 1– 2 gm.Vishishta yoga : Nagaradi kashaya, Kottamchukkadi tail, Adraka khandavaleha, Adraka ghrita, Soubhagya sunti, Panchasama churna,Ajmodadi churna etc. 80
  • 89. Drug Profile VRIDDHA DARUKASanskrit name : Vriddha DarukaLatin name : Argyreia speciousaFamily : ConvolvulaceaeSynonyms : Chagantri, Vrisyagandhika, AvegiVernacular names : Hindi – Bidhara; English – Elephant creeper; Telugu- Samudrapala ; Bengali –Bijatad; Marathi – Samudrashoka ; Gujarati – SamudrashoshaPart used : RootProperties : Rasa – Kashaya, Katu, Tikta; Guna - Laghu, Snigdha Veerya - Ushna Vipaka – MadhuraKarma : Vatakaphahara, rasayana, vrishya.Indication : Amavata, Arsas, Sotha, Prameha, Agnimandya.Major chemical : Seed oil contain oleic acid, Quercetin, Kaempferolconstituents from leaves. seed contain eragine, isoeragine, penniclavine, epifriedelinol,Dosage : Powder 3.0 – 6.0 gm.Vishishta yoga : Vriddhadarukusuma churna, Vriddhadaru kalpa, Ajmodadi churna, Nagaradi modaka. 81
  • 90. Drug Profile SHALLAKISanskrit Name : ShallakiLatin name : Boswella serrataFamily : BursuraceaeSynonyms : Susrava, Gajabhakshya, VrittikaVernacular names : Hindi – Salayi guggul, Kundur; English – Indian olibanum tree; Telugu- Andugu chettu, Sambrani; Bengali – Dhup; Marathi – Salai ; Gujarati – Dhoopado, Malayalam – KunturukkamPart used : Niryasa (gum resin) (Kunduru) & barkProperties : Rasa –Madhura tikta, Kashaya. Guna - Laghu, teekshna Veerya - Ushna Vipaka – KatuKarma : Vatakapha shamaka, twachya, sothahara, vedana shamaka, vrana shodhana, ropana.Indication : Amavata, jwara, kusta etc.Major chemical : Gum resin – Boswellic acid, serrata etc. oil fromconstituents oleoresin contained high content of α-thujene.Dosage : Powder 1-3gms.Vishishta yoga : Bala taila, Trityadi yoga. 82
  • 91. Drug Profile PREPARATION OF DRUGAjamodadi yoga with Shallaki • All 13 ingredients collected from market after proper identification. • Ajmoda, Vidanga, Saindhava, Devadaru, Chitrakamoola, Pippalimoola, Shatapuspa, Maricha, Pippali, Hareetaki, Vriddhadaruka and Sunti should be taken above said parts of powder and it mixed well. • Add equal quantity of above drugs i.e. 34 parts of Shallaki niryasa (Kunduru) powder and mixed it uniformly later prepare the Ajmoadadi yoga with shallaki. • The yoga 2.0 gms per dose orally three times daily ANUPANA “Anupanetu salila meva sreshtam sarvarasa yonitvat Sarvabhuta samyatvat jeevanadi guna yogaccha” (Ch. Chi.Si.)Ushnajala is using as anuapana after drink, liquid to be taken after meals. Water isthe best because it is the chief source of all the tastes, it is accustomed to all livingbeing and possesses the properties of sustaining of life etc.USHNA JALA PROPERTIES: “Maarutasya anulomyam kuryat ushnodakam nrunaan cha” (Ch.Si.4/44)Ushnodakam is vataharam and anulomana. Lukewarm water undergoes swadu vipaka (sweetness at the end ofdigestion) and seta veerya even though used hot. So injudicious use of hot water(either less or more than required) does not cause much change in digestion. 83
  • 92. Drug Profile “Ama vishtabda ……….. Pachyate shipramaharah shanty dravikritah” (A.S.Su.6/36) In conditions of Amaajirna & Vistabdhajirna, the patient should drink warmwater even though not thirsty, just enough to moisten the food and make it liquidlarge quantities of water will destroy the digestive capacity, the obstruction in thestomach caused by accumulated kapha and vata will be released and so the foodliquefied by hot water undergoes quick digestion 84
  • 93. Drug Profile TABLE SHOWING THE GUNAS OF INGREDIENTS OF AJMODADI YOGA WITH SHALLAKIDravya Rasa Guna Veerya Vipaka Action on doshas Other actionsAjmoda Katu, Kashaya Laghu, Ushna Katu Vatakaphahara Deepana, vrishya, ruksha vataanulomanavidang Katu, kashaya, Laghu, Ushna Katu Vatakaphahara Deepana, shoolahara, tikshna, krimighna, vibandhanasaka rukshnaSaindhava Lavana, Laghu, Anushna Mdhura Tridoshahara Deepana, pachana, Vrishya, madhura snighdha, hridya. seetaDevadaru Tikta, Katu, Ruksha, laghu Ushna Katu Vatakaphahara Deepana, adhamanahara, Kashaya jwaraharaChitraka mool Katu Laghu, Ushna Katu Vatakaphahara Deepana, pachana, grahi, ruksha, rasayana. ushna, tikshnaShatapuspa Katu, tikta Laghu, Ushna Katu Vatakaphahara Deepana, shoolahara, tikshna jwaraharaPippalipippalimool Katu Laghu, Ushna Katu Vatakaphahara Deepana, vrishya, rasayana. ruksha, tikshnaMaricha Katu Laghu, Ushna Katu Vatakaphahara Deepana, hridya, shoolahara. tikshnaHareetaki Pancharasa Laghu, Ushna Madhura Vatakaphahara Vataanulomaka, rasayana, (Alavana), ruksha, deepana,pachana Kashaya pradhanaSunti Katu Laghu, Ushna Madhura Vatakaphahara Shoolahara tikshna bhedana,deepana,rechana, vibandha anahaharaVriddhadaru Kashaya, Laghu, Ushna Madhura Vatakaphahara Rasayana, vrishya, deepana, katu,tikta snigdha shoolaharaShallaki Niryasa Madhura, Laghu, Ushna Katu Vatakaphahara Vedanashamaka, sothahara, tikta,kashaya tikshna jwarahara, vranashodhana 85
  • 94. Drug ProfileREFERENCES: 1. Sarangadhara samhita poorva khanda 6/115-119. 2. Bavaprakasha Nighantu 3. Dhanavantari Nighantu 4. Raj Nighantu. 5. Medicinal Plant of Indian Vol. I, ICMR, New Delhi. 6. K.M. Nadkarni, - Indian Materia Medica , Popular prakashana, Bombay. 7. Kirtikara Basu - Indian Medicinal plants, 2nd edition. 8. Wealth of India, part I, Raw materials, CSIR, New Delhi. 9. P.V. Sharma, Dravyaguna Vijnana, vol-II, Choukhambha publication, Varanasi. ******** 86
  • 99. Materials & Methods MATERIALS AND METHODSMATERIALSFor conducting any trial following three materials are needed- 1. The Patient 2. The Parameter 3. The DrugSELECTION OF PATIENTS Uncomplicated patients with characteristic symptoms and sign of amavata,irrespective of age, sex, religion, occupation ect. were selected. Total 44 patientsof amavata were taken for clinical trial from O.P.D.and I.P.D. of Govt. AyurvedicHospital, Erragadda, Hyderabad The patients were selected by symptoms described in text and care has beentaken to select only definite and classical category of amavata patients.CRITERIA FOR SELECTION 1. Saruja sandhi sotha at least one joints. 2. Angamarda 3. Aruchi 4. Trishna 5. Apaka 6. Jwara 7. Gouravam 8. Shoonataanganam 9. Trika sandhi stabdhata 10. Chronicity between one month to six years. 11. Age between 10 years to 70 years. 87
  • 100. Materials & MethodsCRITERIA OF EXCLUSION 1. Age below 10 and above 70 years. 2. Cronicity of less than 15 days. 3. Sandhigata vata. 4. Vatarakta 5. Arthritis with malignancy. 6. Arthritis with other systemic diseases.2. THE PARAMETR The parameters are very essential to know whether the disease isprogressing or regressing. The parameters are subjective and objective. Subjectiveparameters are symptoms or complaints as told by the patient, whereas objectiveparameterare sign and some investigations of the disease.LABORATORY INVESTIGATIONThe fallowing routine investigations like blood, urine along with Rheumatoidfactor (R.F.) is performed. 1. C.B.P.- Complete Blood Picture. 2. Haemoglobin percentage 3. T.L.C. – Total leucocytes count. 4. D.L.C. – Differentials Leucocytes Count. 5. E.S.R. – Erythrocytes Sedimentation Rate. 6. R.F. - Rheumatic Factor. 7. A.S.O. Titer (Anti Streptolysin ‘O’ Titer) 8. C. U.E. –Complete Urine Examination. 9. X-ray Examination. 88
  • 101. Materials & Methods3. SELECTION OF DRUG: According to Ayurveda drug is one among the padachatustaya, which isbasic requirement for the treatment. The drug taken for present study is“AJMODADI YOGA WITH SHALLAKI”MODE AND DOSE OF ADMINISTRATION.a) Mode of administration : Oral.b) Time of administration : Thrice a day, Morning, Afternoon and Evening.c) Anupana : Luke warm water.d) Dose : 2.0 gms/doses Period of study : 40 days.Type of Trial : Single blind. All the patients were advised to allow to fallow pathya-apathyas as explainin disease profile.CRITERIA FOR ASSESMENT OF RESULTS Taking into consideration of percentage of relief in clinical symptoms andclinical parameters after the treatment, the total effect of the therapy was assessedas follows. Result Criteria for assessment CURED 75% to 100% relief in signs and symptoms of Amavata, was taken as Cured MODERATE RELIEF More than 50% to less than 75% relief in signs and symptoms were taken as Moderate relief. MILD RELIEF Patients with improvement in between 25-50% in sign and symptoms were considered as Mild relief. NO RELIEF No change or less than 25% improvement in signs and symptoms were considered as No relief 89
  • 102. Observations & Results OBSERVATIONS AND RESULTS In the clinical study, the disease Amavata has been studied and observed fromtwo aspects. 1. Observation of the disease. 2. Observation of the effect of the treatment.OBSERVATION OF THE DISEASE. The disease has been observed from several angles and all descriptions areframed demographically. 1. SEX WISE DISCRIPTION OF 44 PATIENTS. Sex No. of Patients Percentage Female 33 75% Male 11 25%Out of 44 patients observed, 33 patients were females and 11 patients were men.The percentage value of females was 75% and male, was 25%. It indicates thatamavata occurs irrespective of sex i.e. the incidence of the disease may be seen inboth sexes. But the number of females was greater than males. So the ratio is 3:1. 40 No. of patients 30 20 10 0 Male Female Sex 90
  • 103. Observations & Results2. AGE WISE DISCRIPTION OF 44 PATIENTS. Age (In years.) No. Of Patients Percentage 10-20 04 9.09% 21-30 03 6.81% 31-40 13 29.54% 41-50 14 31.81% 51-60 05 11.36% 61-70 05 11.36% The incidence of amavata in different age group revealed that no age isexempted, however maximum incidence 31.81% was reported in age group 41-50years. 14 12 No. of patients 10 8 6 4 2 0 10 to 20 21 to 30 31 to 40 41 to 50 51 to 60 61 to 70 Age in years 91
  • 104. Observations & Results3. OCCUPATION WISE DISTRIBUTION OF 44 PATIENTS Occupation No. Of Patients Percentage House wife 14 31.81% Laborer 16 36.36% Businessmen 04 9.09% Employee 05 11.36% Student 05 11.36% The incidence of amavata has been more in certain occupation such aslaborers who work in poor hygienic condition, housewives, businessmen,employee and students. In which housewives 14 (31.81%), laborers 16 (36.36%),businessmen 4 (9.09%), employee 5 (11.36%) and student 5 (11.36%). 16 14 12 No. of patients 10 8 6 4 2 0 Housewife Laborer Businessmen Employee Student Occupation 92
  • 105. Observations & Results4. ECONOMIC STATUS WISE DISTRIBUTION OF 44 PATIENTS Economic status No. of Patients Percentage Upper middle 10 22.72% Lower middle 14 31.81% Poor 20 45.45%High incidence of the disease i.e. 45.45% in poor economic condition groupfollowed by 31.81% lower middle economic condition group and 22.72% in uppermiddle economic condition group. No patient founded from rich families. 20 No. of patients 15 10 5 0 Upper Middle Lower middle Poor Economic status 93
  • 106. Observations & Results5. RELIGION WISE DISTRIBUTION OF 44 PATIENTS Religion No. Of Patients Percentage Hindu 30 68.18% Muslim 09 20.45% Others 05 11.36% High incidence of the disease 68.18% founded in the Hindu religionwhereas 9% of the Muslim and 5% of others were noticed 30 25 No. of patients 20 15 10 5 0 Hindu Muslim Others Religion 94
  • 107. Observations & Results6. DIET WISE DISTRIBUTION OF 44 PATIENTS. Diet No. of Patients Percentage Vegetarian 13 29.55% Mixed diet 31 70.455In relation to diet habits the disease occurred more in mixed diet habits i.e. non-vegetarian, who were 31 out of 44 patients (70.45%). The person belongs tovegetarian diet were 13 i.e. 29.55%. 29.55% Veg Mixed 70.45% 95
  • 108. Observations & Results7. ADDICTION WISE DISTRIBUTION OF 44 PATIENTS. Addiction No. Of Patients Percentage Tea/ coffee 30 68.18% Smoking 09 20.45% Tobacco 17 38.63% Betel 09 20.45% Alcohol 09 20.45% No addiction 10 22.72%On the basis of addiction in patients, 68.18% were addicted to tea/coffee where38.63%usedtobacco. 30 25 No. of patients 20 15 10 5 0 Tea/coffee Smoking Tobacco Betel Alcohol No addiction Addiction 96
  • 109. Observations & Results8. PRAKRITI WISE DISTRIBUTION OF 44 PATIENTS PRAKRITI No. of Patients Percentage Vata 09 20.45% Kapha 03 6.81% Vata-kapha 25 56.81% Pitta-kapha 05 11.36% Vata-pitta 02 4.54% The incidence of amavata according to prakriti was as follows , out of 44cases 25 were belongs to vata-kapha prakriti, 9 cases belong to vata prakriti, pitta-kapha prakriti 5, kapha prakriti 3 and vata-pitta 2. Vata-kapha prakriti personswere suffered more (56.81%) than all over prakrities where as pitta prakritipatients were nil. 25 20 No. of patients 15 10 5 0 Vata Kapha Vata-kapha Pitta-kapha Vata-pitta Prakriti 97
  • 110. Observations & Results9. AGNI WISE DISTRIBUTION OF 44 PATIENTS Agni No. Of Patients Percentage Vishama 09 20.45% Tikshna 01 2.27% Manda 34 77.27% On observing Agni it was found that maximum no. of patients 77.27% havefollowed by Mandagni, 20.45% patients have vishamagni. 35 30 No. of patients 25 20 15 10 5 0 Vishama Tikshna Manda Agni 98
  • 111. Observations & Results10. SAARA WISE DISTERIBUTION OF 44 PATIENTS Saara No. Of Patients Percentage Twak saara 18 41% Medo saara 11 25% Asthi saara 15 34% On observing saara, it was found the maximum number of patients 41%have followed by twak saara, where as 34% patients were asthi saara and 25% ofmedo saara. 18 16 14 No. of patients 12 10 8 6 4 2 0 Twak Medo Asthi Saara 99
  • 112. Observations & Results11. DURATION OF ILLNESS WISE DISTRIBUTION OF 44 PATIENTS Duration of illness No. of Patients Percentage (In years) 0-2 24 54.54% 2-4 14 31.81% 4-6 06 13.63% On observing duration of patients, 54.54% have 0-2 years, 31.81 have 2-4years and 13.68 have 4-6 years. 25 20 No. of patients 15 10 5 0 0-2 2-4 4-6 Duration 100
  • 113. Observations & ResultsThe statement shows the observation of clinical symptoms before and aftertreatment. S.N. Symptoms No. of patients Relieving B.T. A.T Per. % 1 Dourbalyam 23 16 30.43 2 Hridayagouravam 26 7 73.07 3 Triksandhi stabdhata 44 13 70.45 4 Angamarda 31 3 93.54 5 Aruchi 44 6 86.36 6 Trishna 15 3 80 7 Alasya 39 19 51.28 8 Jwara 35 0 100 9 Apaka 39 6 84.61 10 Gourava 21 8 61.9 11 Shonataanganam 30 3 90 12 Hastasandhi ruja/soth 42 14 66.6 13 Padasandhi ruja/soth 15 4 73.3 14 Sirosandhi ruja/sotha 4 1 75 15 Gulfasandhi ruja/soth 8 6 25 16 Triksandhi ruja/sotha 9 8 11.1 17 Janusandhi ruja/sotha 23 14 39.1 18 Uru sandhi ruja/sotha 11 8 27.27 19 Vrischikavyavid 9 0 100 vedana 20 Agni dourbalyam 44 7 84 21 Praseka 1 0 100 22 Utsaha hani 7 2 71.42 23 Vairasyam 10 1 90 24 Daha 8 1 87.5 25 Bahumootrata 3 1 66.6 26 Kukshi kathinyata 4 1 75 27 Kukshi shoola 4 2 50 28 Nidraviparyaya 6 0 100 29 Chardi 2 0 100 30 Bhrama 1 0 100 31 Murcha - - - 32 Hritgraham 2 2 0 33 Vitvibandhta 27 2 92.59 34 Jadayantrakunjana - - - 35 Anaha - - - 101
  • 114. Observations & ResultsOBSERVATION OF LABORATORY INVESTIGATION OF 44 CASES OF AMAVATA BEFOREAND AFTER TREATMENT.S.No. Pt.Name TLC in cu/m.m Hb%.(gms) E.S.R. 1st hr/2nd hr R.A.Factor A.S.O Titer B.T A.T B.T A.T B.T A.T B.T A.T A.T. B.T1 S.Begam 5200 5000 11.0 12.0 25/60 10/15 -ve -ve2 B.Laxmi 8000 7500 11.5 11.5 40/80 8/12 -ve -ve3 Azeez be 8500 8000 12.5 12.5 50/65 8/12 -ve -ve4 Venkatma 8000 7000 10.5 11.0 40/60 6/13 -ve -ve5 K.N.Chari 11200 11000 11.0 11.5 60/150 40/85 +ve +ve6 Radha 9200 6500 11.0 12.0 40/70 5/15 -ve -ve7 Asifa bibi 9000 7000 10.5 11.5 60/115 15/25 -ve -ve8 Venkat lal 8000 7500 12.5 12.5 40/60 8/15 -ve -ve9 N.Lingaiah 7500 7000 11.5 11.0 60/95 8/15 -ve -ve10 Kusuma 8500 7000 10.5 10.5 35/135 40/75 +ve +ve11 Asha 9500 6500 12.0 12.5 30/70 7/20 -ve -ve12 Omprakash 11000 8500 10.5 11.5 65/120 35/75 +ve +ve13 Rajitha 11500 7000 11.0 12.5 75/135 5/25 - - +ve +ve14 Pullama 8000 8000 10.5 11.0 60/110 20/30 -ve -ve15 Sanjivi 7500 7000 12.5 13.0 45/65 15/30 -ve -ve16 Sarifa be 7000 4500 11.5 12.0 20/42 15/25 -ve -ve17 B.Madhu 9200 8000 10.5 10.5 100/150 30/50 -ve -ve18 Subamma 9100 5800 10.5 11.0 45/67 40/70 -ve -ve19 Sabitri 9100 5800 10.0 9.5 25/75 35/75 +ve +ve20 Damayanti 8000 7000 12.0 12.0 100/120 10/20 -ve -ve21 Rajallama 9100 8000 9.5 10.5 50/92 6/12 -ve -ve22 Ramesh 7500 6500 13.2 13.5 40/60 5/15 -ve -ve23 Narsimha 6000 4500 12.5 12.0 50/70 10/20 -ve -ve24 Sabunkar P 7500 6000 12.0 12.5 35/75 7/14 -ve -ve25 Yasodha 8000 6000 12.5 12.5 20/42 10/15 -ve -ve26 Anuradha 6500 7000 11.5 12.8 35/75 10/20 -ve -ve27 Radhika 6000 7000 12.0 12.0 45/67 7/15 -ve -ve28 Gayatri 8000 6500 9.5 11.0 35/105 8/15 -ve -ve29 M.Begum 8500 7500 10.0 10.2 100/120 80/105 -ve -ve30 G. Lalitha 6000 6500 12.0 12.5 45/65 10/20 -ve -ve31 Damodar P 9200 8500 10.0 10.0 60/105 40/95 -ve -ve32 Sagar J 11200 6500 12.0 13.0 65/105 5/15 -ve -ve33 Sahina be 7500 7000 10.0 10.8 35/70 25/52 -ve -ve34 Amina 7600 7000 12.0 12.2 30/65 15/20 -ve -ve35 Hajrat be 7200 7500 10.0 9.5 80/102 70/105 +ve +ve36 Sougama 5500 6000 11.0 11.5 70/95 8/12 -ve -ve37 Vasanti 7600 7000 9.0 10.0 70/135 45/102 -ve -ve38 S. Laxmi 7000 5000 11.5 12.0 80/120 8/12 -ve -ve39 M.Gita 8000 7500 12.0 12.0 45/90 6/15 -ve -ve40 M.Tulasi 7000 7200 11.0 11.5 80/105 35/70 -ve -ve41 Anadalama 8500 8000 10.0 10.5 65/120 35/67 -ve -ve42 Sakina 9200 7000 10.5 12.0 75/120 5/15 -ve -ve43 Lingama 8500 6000 11.0 12.0 65/115 10/15 -ve -ve44 Ramaiah 9000 6500 13.0 13.0 65/135 5/15 -ve -ve 102
  • 115. Observations & ResultsApart from clinical observation the following have been observed by laboratoryinvestigation. 1. Urine Examination: Nothing abnormal detected in any patient in physical, chemical and microscopic examination. 2. Blood Examination: Before the treatment Leucocytosis noticed, raised E.S.R., decreased haemoglobin level observed in many cases and Rheumatic factor positive was recorded in five cases only. A.S.O. titer positive also found in one cases of Amavata. After the treatment, leucoocyte count was seen in normal in many cases; marginal improvement of haemoglobin percentage was noticed. But Rheumatic factor and A.S.O. titer was still remained positive after the treatment in related cases of Amavata. 103
  • 116. Observations & Results RESULTS The basis for the assessment of results was the response shown by thepatients regarding the sign and symptoms of Amavata along with improvement oflaboratory investigations. The overall effect of therapy is as follows Result No. of Patients Percentage Cured 29 65.91% Moderate relief 06 13.64% Mild relief 06 13.63% No relief 03 6.81% Cured result was observed in 29 patients i.e. 54.54% where patients gotrelief from 75% to 100% of symptoms after the treatment, Moderate relief was in6 patients i.e.13.63% where patients got relief from 50% to less than 75% ofsymptoms. Similarly Mild relief was in 6 patients i.e. 13.63% where patients gotrelief from 25% to less than 50% and Mild relief was seen in only 3 patients of all44 patients i.e. 6.81% where patients got relief less than 25% of symptoms aftercompletion of treatment. PIE DIAGRAM OF OVER ALL RESULTS 6.82% Cured 13.64% Moderate Relief Mild relief 13.64% No relief 65.91% The result has been also presented in the form of Master Chart. 104
  • 117. Discussion DISCUSSION All the factors which causes the Mandagni leads to the production of Ama,which inturn vitiates the doshas and causes the disease Amavata, and characterizedby Trikasandhi Stabdhata, Saruja sandhisotha, Agni dourbalyam etc. According totextual description, consumption of guru, snigdha, viruddha ahara and viharaswere found as causative factors. The present clinical study on Amavata, the incidence of the disease may beseen in both sexes but number of females was greater than that of males whichindicates a comparatively greater incidence of Amavata in females. Theobservation of the disease, according to age reveals the maximum incidence ofAmavata in persons from 31 to 50 years of age. The minimum incidence of thedisease was noticed in age group of 21-30 years. The age group, which belongs topitta, was affected least as it keeps the Agni in good condition. As the poor socio-economic families don’t follows the aharavidhivisheshayatanas and consumptionof asantulita ahara, the occurrence of the disease was more in this families but nopatients founded from rich families in this study. Similarly the incidence of thedisease was more in laborers who work in poor hygienic conditions, andhousewives, due to her irregular diet habits. The incidence of the disease alsoreported in Businessmen, employee and students. The incidence of disease washigh in the Hindu religion where the Muslim and other were also noticed whybecause the observing place was the Hindu dominant area. In relation to thedisease to food habits the disease occurred in mostly in non-vegetarians (mixed)diet, which were 31 out of 44 patients and vegetarians were 13 only. The diseasewas also observed in all addicted or non-addicted person but more patientsfounded from tea/coffee addiction. 107
  • 118. Discussion The incidence of the disease according to deha prakriti, the vatakaphaprakriti persons were suffered more than all over prakriti where as pitta prakritipatients were nil. The present study also showed the maximum number of patient hadfallowed by Mandagni but there was no patient from Sama agni condition.Similarly which the diseases, was observed according to sara, 41% patients foundfrom Twaka sara, 34% patients Asthi sara and 25% from medo sara where as othersara dominant patients were nil. When disease was observed by present symptoms in the patientsbefore the treatment, Trika sandhi stabddhata, Agnidourabalyam, Aruchi Sarujasandhi sotha were found in all the cases of Amavata. In involvement of sandhi,hasta sandhi was more i.e. 42 in 44 patients, pada sandhi found in 15 of 44patients, siro sandhi in 4 patients gulfa sandhi in 8 patients, trika sandhi in 9patients, janu sandhi in 23 patients and uru sandhi in 11 of that of 44 patients.After completion treatment the maximum number of patients were corrected fromthese symptoms. Trika sandhi stabdhata found in only 13 of 44 patients, Agnidourbalyam in 7 of 44 patients, aruchi in 6 of 44 patients. Hasta sandhi ruja sothawas only 14 of 42 patients pada sandhi ruja sotha in 4 of 15 patients, siro sandhisotha ruja in only one of 4 patients, Trika sandhi sotha ruja in 8 of 11 patients afterthe treatment. No single joint was involved in any patient during the observation. In hastasandhi, parvas (Phallangeal joints), manibandha sandhi (wrist joints) were moreaffected than other joints of the hand. Next affected joint was karpoor sandhi(elbow joints). The involvement of hasta sandhi was mostly noticed in pravidhaamavata. Nature of spreading of joint involvement occurred in two variteis – a)Bhramanasheelatwa (migratory type) 2) Prasaranasheelatwa (spreading type).Bhramana sheelatwa means first disease involves in joint and next travels to other 108
  • 119. Discussionjoint, and then first joint will be free of pain and swelling. Prasaranasheelatwameans first manifests in one joint and next manifest in other joint but no relief infirst joint. It spreads from joint to joint. These two features observed each of 20and 24 patients. The stiffness or stabdhata are recorded in all joints involved andaggravation of sandhi stabdhata in early hour of the day before the treatment. Before the treatment, Angamarda presented in 31 of 44 patients,shoontaanganam was in 3o of 44 patients, these symptoms maked the patients tolie on the bed constantly where nidra viparyaya noted as 6 patients of 44. Butafter the treatment Angamarda and shoonatanganam were only 3 of 44 patients.Similarly nidra viparyaya completely relieved from that of 6 patients. Jwara observed in mostly in acute cases, it was found in 35 of 44 cases, theseverity of jwara recorded as high as 104°F. Jwara was also present mildly insome apravidha amavata cases. The fall of temperature noticed with profusesweating. Daha in 8 of 44 cases, trishna in 15 cases and bhrmaa in only one casesnoted during Jwara before the treatment. After the treatment the all-35 patientswere corrected from jwara and one patient from Bhrama but trishna still remainedin 3 of 15 cases. In one case where temperature was 104°c we bought help ofAyush 64 and Godanti bhasma with the trial drug. The 23 cases of Dourbalyam, 26 cases of hridaya gouravam, 39 cases ofalasya and apaka, 21 cases of gourava and 7 cases of utsaha hani were recordedbefore the treatment. These all symptoms were due to hypo function of Agni, theingested food particle could not be properly digested and it produced ama, lead todeprive nutrition and increase the blood viscosity. These symptoms disappearedafter certain duration of treatment from maximum number of patients.Dourbalyam found in only 16 of 23 patients, hridaya gouravam 7 in 26 patients,alasya in 19 of 39 patients, apaka 6 in 39 patients, gourava in 8 of 21 patients, andutsaha hani was only two in 7 cases after the treatment. 109
  • 120. Discussion Praseka in one patient and vairasyam found in 10 of 44 patients also foundbefore the treatment where praseka was completely relieved from the patient butvairasyam still remained in only one cases of the disease after the treatment.Similarly vid vibadhata was recorded in 27 of 44 patients. This feature waspresent in most of the patients before occurance of the disease and it wascontinued. Bahumootrata was present in 3 cases of 44 before the treatment whereonly 2 patients of 27 cases vitvibandhata and 1 patient of 3 cases of bahoomutratafound after the treatment. Hritgraha was represent in only one cases of the patient,complain was chest pain (Retrosternal or pericardial nature), heaviness in thechest, palpitation, tachycardia more during febrile condition. The patient had pasthistory of rheumatic fever, which she was 12 years of age. After treatment, thesymptom still remained and result was ‘no cure’. The symptoms like kukshishoola, kukshikathinyata were found in 4 of 44cases, chardi was in 2 of 44 cases whereas moorcha, jadyaantrakunjana and anahawere nil before the treatment. After certain treatment Kukshishoola was seen ofonly two and kukshikathinyata in only one of 4 patients whereas chardi wascompletely relieved from that of 2 patients. Leucocytosis, raised E.S.R., decreased haemoglobin level observed inmany cases and Rheumatic factor was positive in 5 cases. In almost 27 of casesE.S.R. level became normal and marginal improvement of Hemoglobin wasnoticed but there were no changes in Rheumatic factor after the treatment. A.S.O.Titre positive also had been seen in one case of Amavata. It was also remainedpositive after the treatment. The disease Amavata is stated to be produced by Amarasa when enteredinto circulation through initiation of vata dosha. According to modern medicalscience in the rheumatic disease such as rheumatic fever, rheumatic arthritis /Rheumatoid arthritis, which are having similar clinical features to some extent to 110
  • 121. DiscussionAmavata are said to be result of antigen and antibody reaction. That Antigen maybe sole amarasa, but it may be part of it. In view of above discussion it may besaid that antigen forms a part of ama and we can assume that of sroto vaigunyatatakes place in the hridaya and settles there and manifests features of rheumaticfever basing from Hridaya, it causes damage to hridaya. If srotovaigunyata takesplace in joints, and settles there and manifests the features of rheumatic arthritisbasing on joints and it causes damage to joints. As we know Agnimandya is initiating factor for the formation of ama,which is the root cause of the disease, hence all efforts are directed towardsimproving the Jatharagni which is expected to give good response is the disease.For the improvement of Jatharagni and for the digestion of ama, langhana anddeepana, pachana and tikta rasa predominant drug and diet recommended. It isobious that all the ingredients in present trial drug ‘Ajamodadi yoga withShallaki’, possess laghu, ushna, ruksha, deepana pachana properties and could beresponsible for the better result. Ajmodadi yoga is recommended as a specific for Amavata (Sharangadharasam.6/115-119). Its ingredients have agnideepana, amapachana, vataanulomana,jwarahara, shoola hara vedana shamaka, rechana, sothahara, vatakapha shamaka,rasayana, vrishya properties etc. Hence it acted at the Samprapti vigahntana.Shallaki niryasa (gum resin of boswellia serrata) was investigated by scientist atthe RRL for efficacy against inflammatory disorder that produced no adverse andundesirable side effects (RRL news letter Jammu, India, 1982, 9(3)). It has alsoanalgesic and antipyretic effect. The gum resin of shallaki also was found toexhibit significant pain relieving effect in rats. It is useful in rheumatism andnervous disorder (Wealth of India Vol.1). So these properties of the drugsexpected to give good improvement in Amavata. 111
  • 122. Discussion The overall effect of the treatment indicates very good effect of the drugsince most the patients have been substantially improved. It may be seen that thepresent study has been able to conclusively demonstrate the efficacy of thecompound formulation ‘Ajamodadiyoga with Shallaki’ in the treatment ofAmavata. ******** 112
  • 123. Conclusion CONCLUSION The present clinical trial is undertaken mainly to evaluate the efficacy ofAjmodadi yoga with shallaki, in Amavata on selected 44 cases. The total number of patients taken for clinical trial was 44. The patientsinclude both males and females from 13 to 66 years of age. The disease was observed by several angles such as sex, age, occupation,economic status, religion, diet, addiction, prakriti, Sara and agnibala wise. The clinical profile shows that the females are comparatively more prone tothe disease than male in this locality. It is observed that the incidence of thedisease is more in middle age of group i.e. 31 to 50. The poor socio-economicgroup people are more suffered. During the clinical study the more patientssuffered from the Hindu religion than others because the observing place was theHindu dominant area. Most of the patients were non vegetarian and habituated totake fatty and protein diet. The maximum numbers of patients were tea/coffeeaddicted. The individuals having vata-kapha prakriti were more prone to thedisease. The higher incidence of the disease observed in twaka sara and asthi sarapurusa and mandagni was the prime factor for the pathogenesis of the disease. The patients were clinically examined and their blood samples were takenfor routine tests like TLC/DLC, Hb percentage, ESR, and R.F.ect. Most of thepatients had angamarda, aruchi, agnimandya, jwara, gatra stabddhata and sandhisotha/ rajas. E.S.R. was seen more elevated in most of the patients especially in thosewho had jwara, agnimandya with sotha/ruja in sandhis. 115
  • 124. Conclusion The drug administrated only after clinical examination of the patients,besides depending on the laboratory investigations. The compound preparation was given as a dose of 2 gms, thrice a day withLuke warm water. All the amapachana, vataanulomana, measures were strictlyimplemented. It is observed that the cases of acute onset are responded well withthe preparation in less duration, where as long standing cases partial results areobserved though the treatment are continued for the full course of 40 days. Regarding the mechanism of the drug, Ajmodadi yoga with shallaki, isconcerned, the all ingredients of Ajamodadi yoga possess definite properties likedeepana, pachana, vata-kapha hara which help in resolving the pathogenesis.These qualities promote the agni and exhaust ama leading in turn the cessation ofthe chain of event in pathogenesis. The other ingredients i.e. Shallaki issothahara, vedana shamaka, jwarahara along with vata-kapha shamaka so it haveunexpected ability to improve the symptoms of the Amavata without any toxiceffects. This to conclude, it can be said that Ajmodadi yoga with shallaki is aeffective drug to combat the evolution of the disease “AMAVATA”. We hope thisstudy will show the way of further study. ******** 116
  • 125. Summary SUMMARY The thesis entitled ‘ A clinical study of the effect of Ajmodadi yoga withShallaki in the management of Amavata’ may be summarized as below. - The cardinal symptoms of the disease Amavata already described in Charaka Samhita in Grahani Chikitsa, Vatavyadhi chikitsa etc., but Madhavakara was the first to describe it is a separate disease entity with it etiology, pathogenesis, signs and symptoms and prognosis in his period about 700A.D. - Chakrapani first time gave the line of treatment for Amavata along with many combinations of drugs in 11th Century. - Amalakshanas, Trika sandhi vedana, Gatra stabdata and saruja sandhi sotha etc., characterize Amavata. - Ama and vata are the most important factors in etiopathogenesis of the disease. - The Apakwa ahara rasa, which gets statis and sukatwa in Amashaya due to Mandagni is called Ama. - Ama, Sama and Amavisha conditions appears to be different states of Amarasa. - Mandagni is the main causative factor for the disease Amavata. - Vitiated vata and kapah doshas are causative factors for the disease. - The disease originates from abhyantara rogamarga and manifests the clinical feature in madhyama rogamarga. 113
  • 126. Summary- Sleshma sthanas such as Amashaya, sandhi, hridaya are the dooshyaas.- Amavata can be diagnosed easily basing on its clinical picture.- Amavata can be differentiated from other joint disorders such as Vatarakta, sandhi vata, krostuka sheershaka etc., because of its specific characteristics.- Usually the disease Amavata is krichra sadhya but it is asadhya if any change occur in effected organs.- The aim of the treatment in Amavata is to prevent the production of Ama, expulsion of existing ama from the koshta, and oxidation or pachana of circulated ama at dhatu level.- An ideal drugs for treatment of Amavata should consists of Tikta katu rasa, katu vipaka, ushna veerya and possessing deepana, pachana, rechana and rasayana karmas.- In view of line of treatment of Amavata, Ajmodadi yoga with Shallaki was taken for study.- A total number of 44 patients suffering from Amavata were selected fro the present study.- Ajamodadi yoga with Shallaki administered with Ushnajala in dose of 2gm thrice a day for 40 days.- Diet was given according to the condition of the patients.- Ajamodadi yoga with Shallaki has been found to be an effective compound drug in the Amavata.- No side effect have been noticed during the period of treatment with the drug. 114
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