Amavata kc024 hyd

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CLINICAL STUDY OF THE EFFECT OF AMRITA MANJARI & ERANDA BRISTA HAREETAKI IN THE MANAGEMENT OF AMAVATA, D. USHA MADHURI, Department of Kayachikitsa, PG unit Dr.BRKR Govt. Ayurvedic College, HYDERABAD

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Amavata kc024 hyd

  1. 1. A CLINICAL STUDY OF THE EFFECT OF AMRITA MANJARI & ERANDA BRISTA HAREETAKI IN THE MANAGEMENT OF AMAVATA Dissertation submitted in partial fulfilment for the degree of DOCTOR OF MEDICINE (AYURVEDA) In KAYACHIKITSA By Dr. D. USHA MADHURI B.A.M.S GUIDE Dr. PRAKASH CHANDER. M.D. (Ay.) Head of the Department 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 2008Clinical study of the effect of Amrita Manjari and Erandabrista Haritaki in the management of Amavata 1
  2. 2. “Namami Dhanvantarimadi Devam, Surasurairvandit Padapadmam | Loke Jararugbhay Mrutyunasham, Datarmisham Vividhoushadhinam ||”Clinical study of the effect of Amrita Manjari and Erandabrista Haritaki in the management of Amavata 2
  3. 3. A CLINICAL STUDY OF THE EFFECT OF AMRITA MANJARI &ERANDA BRISTA HAREETAKI IN THE MANAGEMENT OF AMAVATA Dissertation submitted in partial fulfilment for the degree of DOCTOR OF MEDICINE (AYURVEDA) In KAYACHIKITSA By Dr. D. USHA MADHURI B.A.M.S GUIDE Dr. PRAKASH CHANDER. M.D. (Ay.) Head of the Department 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 2008Clinical study of the effect of Amrita Manjari and Erandabrista Haritaki in the management of Amavata 3
  4. 4. Dr. N.T.R. UNIVERSITY OF HEALTH SCIENCES VIJAYAWADA POST GRADUATE 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 original observationsmade by Dr. D. Usha Madhuri on ‘A Clinical Study of the effect of Amrita Manjari &ErandabristaHareetaki in the Management of Amavata’ for the degree of ‘Doctor ofMedicine’ (Ayurveda) . This work has been completed under my direct supervision after a seriesof a scientific discussion. The scholar has put in commendable effort for designing and executing the methods and plansfor the study. The results achieved through this work are authentic and reproducible. Hence I recommendthis dissertation to be submitted for adjudication. GUIDEDate: Dr. PRAKASH CHANDERPlace: Hyderabad. MD (Ayu) Head of the Department Post graduate Department of Kayachikitsa Dr. B.R.K.R. Govt. Ayurvedic College, Hyderabad.Clinical study of the effect of Amrita Manjari and Erandabrista Haritaki in the management of Amavata 4
  5. 5. Dr. N.T.R. UNIVERSITY OF HEALTH SCIENCES VIJAYAWADA POST GRADUATE 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 original observationsmade by Dr. D. Usha Madhuri on ‘A Clinical Study of the effect of Amrita Manjari &ErandabristaHareetaki in the Management of Amavata’ for the degree of ‘Doctor ofMedicine’ (Ayurveda) . This work has been completed under my direct supervision after a seriesof a scientific discussion. The scholar has put in commendable effort for designing and executing the methods andplans 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. PRAKASH CHANDERPlace: Hyderabad. MD (Ayu) Head of the Department Post graduate Department of Kayachikitsa Dr. B.R.K.R. Govt. Ayurvedic College, Hyderabad.Clinical study of the effect of Amrita Manjari and Erandabrista Haritaki in the management of Amavata 5
  6. 6. ACKNOWLEDGEMENT At this unforgettable moment, I prostrate my head on the feet of our aradhya devaLORDGANESHA for deputing me to serve the mankind.I take utmost pleasure and feel privileged to express my deep sense of gratitude and extremeindebtedness to my Guru and Guide Dr. PRAKASH CHANDER, M.D. (Ayu), Professor, Headof the Department, Post Graduate Dept. of Kayachikitsa, Dr. B.R.K.R. Govt. AyurvedicCollege, Hyderabad for his constant and valuable guidance, encouragement throughout thedissertation work. Undoubtedly the correct, affectionate and untiring guidance of my Guru hasbeen a greatest asset in its completion.I express my heartful gratitude to Dr. V. Vijay Babu, MD (Ayu), Reader, PG Dept. ofKayachikitsa, Dr. B.R.K.R. Govt. Ayurvedic College, Hyderabad, for his 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-guide forthe first six months of my work.I pay my sincere respect to Dr. M. Sadashiva Rao, principal of Dr. B.R.K.R Govt. AyurvedicCollege, Hyderabad for providing facilities for the research work.I am thankful to Dr.V.L.N.Sastry, 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 and Dr. M.Philip Anand Kumar, HOD of P.G. Dept. of Dravyaguna for his kindly co-operation.Clinical study of the effect of Amrita Manjari and Erandabrista Haritaki in the management of Amavata 6
  7. 7. I cordially acknowledge my friends and colleagues Dr.G.Kavitha, Dr.D.Alibasha,Dr.T.SrinivasRao,Dr.K.Pardhasaradhi,,Dr.V.Jayalakshmi,Dr.K.Suneetha,Dr.Namrata,Dr.K.srinivas,Dr.NagaRaju,Dr.Mangalakanthjah,Dr.SambhasivaRao,Dr.NageswarRao,Dr.K.NandaKumar,Dr.J.Shivanarayana,Dr.G.Lavanya,Dr.SivaRamakrishna,Dr.Ch.HarithaLakshmi,Dr.A.Puskala, G.Sumathi and others who helped me in one way or other in completingthis work.I acknowledge my brother D.VamsiKrishna and my cousin M.PradeepKumar for their DTPwork and statistical analysis.I express my special thanks to my husband A.Madhu and father-in-law Sri A.Anjaiah,mother-in-lawSmt.A.Eshwaramma for their co-operation,concern and care in completing this work.I pay my special thanksmy beloved father Sri D. Satyanarayana , my beloved mother SmtD.Sujatha, mysister AshaJyothi,mybrotherD.Vamsikrishna, mygrandmotherSmt.Subbammaand my grand father LateSriNagaiah their incessant love and blessings was constant drivingforce behind my progress.I am highly grateful to the authors of all the books and articles which have been utilized by meas 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 helped medirectly or indirectly for this project work.Dr.D.Usha MadhuriDate:Place: HyderabadClinical study of the effect of Amrita Manjari and Erandabrista Haritaki in the management of Amavata 7
  8. 8. CONTENTS INTRODUCTION 1. HISTORICAL REVIEW PART-I LITERARY REVIEW 2. CONCEPT OF AGNI 3. CONCEPT OF AMA 4. DISEASE PROFILE  NIDANA  SAMPRAPTI  ROOPA  SADHYA-ASADHYATA  SAPEKSHA NIDANA PRINCIPLE OF TREATMENT  CHIKITSA KARMA  PATHYA PATHYA 5. DRUG PROFILE PART-II CLINICAL STUDY 6. MATERIAL AND METHODS 7. OBSERVATIONS AND RESULTS 8. DISCUSSION 9. SUMMARY 10. CONCLUSION 11. BIBLIOGRAPHY 12 ANNEXUREClinical study of the effect of Amrita Manjari and Erandabrista Haritaki in the management of Amavata 8
  9. 9. 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. 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. B.R = Basavarajeeyam Bh.R. = Bhisajyaratnawali. 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 treatment Y.R. = Yoga ratnakara.Clinical study of the effect of Amrita Manjari and Erandabrista Haritaki in the management of Amavata 9
  10. 10. Clinical study of the effect of Amrita Manjari and Erandabrista Haritaki in the management of Amavata 10
  11. 11. INTRODUCTION The growing prevalence of Rheumatological disorder amongst million of people of theworld has become a serious health concern. Today over 100 million urban and rural Indiansare seriously suffering from Rheumatological disorder. What’s more alarming is that not onlythe urban or rural men and women, but nearly 1% children have same problem. Rheumatology, a branch of Internal medicine, which deals with musculo skeletalsystem and connective tissue and with those, generalized conditions, which present with boneand joint pain. The musculoskeletal disorders are more crippling and hamper the economy ofthe individual as well as the world, which are 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 Spondylo Vatarakta Apbahuka arthopathy Khalli vata Sandhi vata The word ‘Amavata’, itself explanatory term that indicates Ama and vata are the mostimportant factors in aetio pathogenesis of the disease. In Vedic scripture such as Rigveda andAtharvaveda, where ‘Ama’ word interpreted as Ama, Amat, Amayat, Amayatam (Rigveda),Amaya, Amayam (Atharvaveda). The Ama has been compared with visha and its role incausing disease described in Atharva veda. Charaka described ‘Ama’ as disease and causativefactor of many diseases. Charaka has also used the term ‘Amavata’ in sotha chikitsaClinical study of the effect of Amrita Manjari and Erandabrista Haritaki in the management of Amavata 11
  12. 12. (Ch.Chi.12/51), Pandu roga chikitsa (Cha.Chi.15) and vatavyadhi chikitsa (Ch.Chi.28) andcardinal sign and symptoms of Amavata has been described in Grahani Chikitsa (Cha.Chi.15).Susruta mentioned term ‘Ama’ reference of vidradhi chikitsa and Amajeerna in Udara roga butdid not use the word ‘Amavata’. Vagbhata first time has given detailed description of Ama.He said malfunctioning of Agni produces Ama. Madhavakara first described ‘Amavata’ asindependent disease entity along with its etiology, pathogenesis, sign and symptoms, prognosisand complication. Chakra datta was first to describe the line of treatment with manycombination of the drugs. People are not conscious about their food habits, which disturbing agni and producingama. Busy life style i.e., immediate exercise after taking heavy and incompatible food,indulging in fast food, stored food, freezed food may further disturbed the agni and produceama and increase the vata simultaneously, this leads to more incidence of Amavata in society,presents alasya, gourava in hridaya, jwara, saruja sandhi sotha, aruchi etc., and make aindividual suffering. Clinical research on Amavata has been undertaken at different centers. SomeAyurvedic physician correlated it with Rheumatoid Arthritis and some with Rheumatic fever.But Amavata appears to be a group of Rheumatic / inflammatory musculo skeletal disorder oncomparison with modern view and it should be diagnosed and treated on Ayurvedic line only. The disease Amavata belongs to madhyama roga marga according to manifestations ofsymptoms (A.H. Su.12/47). But actually the production of the disease or vyadhi samuthanatakes place in annavaha srotas or kosta, which belongs to abhyantara roga marga. Theproduction of ama and vata (samana) vikriti, vata dosha samurchana takes place in Amashayaand Pakwashaya, hence the origin of the disease to be of abhyantara roga marga. But themanifestation of clinical features appears, in the organ belongs to madhyam roga marga.Hence it can be said that the disease involves both abhyantara and madhyama roga margas. The disease has been considered to be the most painful and greatest cripplier ofmankind. It not only affects the joints but also has systemic effects leading to variouscardiovascular, neurological and heamotological manifestation, thus making the disease moreClinical study of the effect of Amrita Manjari and Erandabrista Haritaki in the management of Amavata 12
  13. 13. 2 complicated. Its incidence is common in our country; most of the poor, rural masses sufferwith the disease. Despite profound advancement in modern system of medicine, in the cure forthe disease is still an enigma.Taking all this account it is thought that there is a great need to study and understand‘Amavata’ in its whole aspects, hence it is initiated me to study in the disease and treatment. Regarding the treatment of the disease, the modern drug treatment consists of non-steroid anti-inflammatory drugs (NSAID),Diseases modifying anti-rheumatic drugs (DMRD)and steroids, but all are hazardous to health as they cause many side effects. In Ayurveda, thetreatment of the disease quite successful as it is more etiologically oriented and resultproducing with no side effect. Therefore, the present study with ‘Amrutha Manjari withArdraka swarasa and Erandabristahareetaki with luke warm water’ a compound drug hasbeen taken for clinical trial. *******Clinical study of the effect of Amrita Manjari and Erandabrista Haritaki in the management of Amavata 13
  14. 14. Clinical study of the effect of Amrita Manjari and Erandabrista Haritaki in the management of Amavata 14
  15. 15. Historical Review Ayurveda is as old as humanity, is originated in India long back in pre vedic period.Rigveda and Atharvanaveda have references on health and diseases. Ayurveda texts likeCharaka samhita and Susrutha samhita were documented about 300 years BC.The termAyurveda means science of life. It deals elaborately with measures for healthful living duringthe entire span of life and its various phases. Ayurveda deals both with preventive and curative aspect of life is a mostcomprehensive way. Who’s concept of health propounded in modern era bears a closesimilarities to these principles. References to medicines are found in the earliest works including the Vedas. But therehave been no references available about the presence of AMAVATA during Vedic kala sinceVedic scriptures are concerned as the earliest recorded writings. The entire period may be divided into four parts- 1. Vedic Kala (Ancient period) 2.SamhitaKala (Classicalperiod) 3.SangrahaKala (MedievalPeriod) 4.AdhunikaKala (ModernPeriod) Vedic Kala (1500-800 BC): -Vedic kala is the period when Aryan compiled fourVedas i.e1500 to 800 BC.1During this period Ayurveda was perhaps the only system of overall health care and medicine,which served the people in such crucial areas as health sickness&life as whole. There has been no reference available about Amavata during the vedic kala.But we can get the word ‘Ama’, ‘Amat’, ‘Amayatam’. Amayatam words in rigveda inpippledhasaka, Atharva veda also ‘Amaya’, ‘Amayam’ words are mentioned while describingchayapachaya kriya in amavishakta hetu rogas. The concept of ama, its similarity with vishaand its role in causing diseases has been described. The word ama also appears in Panini unadisootra and Kshya gruhya sootra.2 In this connection it is clear that the knowledge of ama andits role in causing disease have been established in vedic period. Anyhow the word ‘Amavata’and disease and its description is nowhere found in vedic literature.Clinical study of the effect of Amrita Manjari and Erandabrista Haritaki in the management of Amavata 15
  16. 16. Samhita Kala (700 B.C to 500 AD): In this period we do not find any description of any types of joint disorders under theheading of amavata. But as already mentioned the description of ama and diseases caused byama are available in Bruhatrayee. Charaka described in Trividha Kuksheeyadhyaya of Vimana 3Sthana about production of ama, its similarity with visha gunas and its role causing thediseases in detail. The word Amavata is also mentioned in Sotha and Pandu chikitsa adhyaya inCharaka Samhita 4(Ch.Chi 12/52, Ch.Chi 16/61-63) and its related cardinal symptoms also has 6been elaborated in Grahani Chikitsa (ch. chi/150) Vata vyadhi chikitsa adhyaya (ch.chi 28) In this period few diseases characterized by joints involvement with pain and swellinghave been found in Vate rakta, Sandhigata vata, Krostuka Sheershaka etc. the diseaseVatarakta is found in all samhitas. Some symptoms of amavata such as greevastambha,trikagraha, involvement of janusandhi were described under nanatmaja vata rogas.7 Bhela samhita also has no description about Amavata but described about Ama. InHareeta Samhita, Amavata described in detail providing full chapter, the involvement of joint 8with relation to gastro intestinal disturbance was noticed.Samgraha Kala (600 AD to 1600 AD): In this period Vaghbhata was first author to give a detail description about Ama. AsVaghbhata is first Samgrahakaka and his period about 600 AD. He described samavata in 9Astangahrudaya also stated that samavata is combination of ama and vitiated vata. But thesign and symptoms described under this heading are different from amavata disease, which weunderstand now. Among the books available of this period with Amavata description ofMadhava nidana seems to be oldest. The author of Madhava nidana (rugvinischaya) was thefirst describe it as a separate disease entity in his period about 700 AD. He described in detail 10including its etiology, pathogenesis , sign and symptoms and prognosis. Chakrapani in 11thcentury in his text chakradatta for the first time gave the line of treatment for Amavata along 11with many combination of drugs. Various books of this period like Yogaratnakara, BhaisajyaRatnavali, Sharangadhara Samhita, Gadanigraha also prescribed some more combination ofClinical study of the effect of Amrita Manjari and Erandabrista Haritaki in the management of Amavata 16
  17. 17. drugs. In Bhava prakasha samhita also a detail description of Amavata including the line oftreatment is available. 12In addition Bhavamishra described a distinct variety of Amavata caused by Phirangaroga i.e.Syphilitic arthritis and also prescribed a specific therapy drugs for Phiranga janya amavata the 13drugs like Rasa karpoora, Chopa chinyadic etc.Adhunika Kala (1600 AD onwards): In this kala an attempt has been done to incorporate to the available knowledge inayurveda. Dr Gananatha Sen has done pioneer work in the field of reorientation about conceptof diseases and their diagnostic methods. He is of the opinion that all diseases of the joints withswelling and pains either of acute or chronic onsets, may be regarded as sandhivata. He hasfurther classified it into five types in which Rasavata is also included. Rasavata is a newnomenclature, which he has suggested as synonym to Amavata is a disorder to express this factmove clearly, that this disease is caused by Rasa, which has been incompletely processed. Thepresent trend is to classify the joint lesion into two groups. 1) Samavata 2) Niramavata. Whenthe joint lesion associated with inflammatory manifestation (the symptoms of ama) along withthe constitutional symptoms fever, anorexia and indigestion Samavata.14 In contrast to its whenthere is pain and 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 on the basis ofclinical manifestation and aetiopathogenesis, Rheumatoid Arthritis of today may also includein Amavata. *******Clinical study of the effect of Amrita Manjari and Erandabrista Haritaki in the management of Amavata 17
  18. 18. REFERENCES: -1. Science and Philosophy of Indian Medicine – K.N.Udupa- Baidyanath publication 1978, 1stedition.2. Brijpal Sharma – Amavata and its treatment.3. Charaka Samhita, 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, Amavatadhikarah Chapter 26.13. Bhavaprakash Madhya Khanda, Chikitsa Prakarana, Phirangaroghadhikara Chapter 5914. Gananatha Sen- Saidhantika Nidana part-II. ******Clinical study of the effect of Amrita Manjari and Erandabrista Haritaki in the management of Amavata 18
  19. 19. Clinical study of the effect of Amrita Manjari and Erandabrista Haritaki in the management of Amavata 19
  20. 20. Clinical study of the effect of Amrita Manjari and Erandabrista Haritaki in the management of Amavata 20
  21. 21. CONCEPT OF AGNI Agni in general means fire. “Agni: pum, tejah padarthe visheshah”1Agni is a factorpossessing ‘Teja’ Mahabhootamsa. In Vachaspatyam Agni is defined as “nayateparinamayateeti.” Agni maintains organisms’integrity and vitality by converting the food consumed invarious ways into various structural and functional components and also to provide the energyto perform vital activities through paakadi karmas. All the material consumed by human through the routes of ingestion, inhalation andinjections must get digested, absorbed and assimilated through the agency of agni only. 2 Agni is defined as agni guna janaka mevacha na dravya janakam. All the functionsattributed to Agni whether it is jathara, bhoota, dhatwagni can be summed into two aspects 1) Dhatu nirmana 2) Dhatu karmas. Agni is not only for ahara pachana and dhatunirmana but also for yielding energy forbalam, vyayama shakti, vyadhinirodhaka shakti and utsahotsadi karyas which are all attributedto agni3. Charaka quoted “agni is the only factor whose purpose is survival of human being andwhose absence is death.”4 According to Annambhatta in his nyayabhodini on tarka sangraha , agni is one of fivemahabhutas known as tejas. It is of two varieties nityam and anityam.Nityam is paramanu rupa and anityam is karya rupa. Again anityam is of three types. 1. Sariram - in solar region – Aditya loka 2. Indriyam - in eye – chakshu 3. Vishaya - object- this is four folds1Clinical study of the effect of Amrita Manjari and Erandabrista Haritaki in the management of Amavata 21
  22. 22. a) Bhouma - fire etc b) Divya - lightning etc c) Audaryam - the cause of digestive of ingested food (Jatharagni) d) Akarajam - produce in mine (Gold) 5 Agni reva shareera pittantargatah… (C.Su.22/11) Agni is considered as pitta in the system. The term pitta is derived from the root tap toheat or to burn.6Tap aishwarye, tap daha and tap santapa are dhatus derives the pitta. 7Tap aishwarye – to make one achieve the eight kinds of benefits. 8 .8Tap daha – to act of burning of the nutrition consumed 8Tap santapa – to generation of heat. In Ayurveda pitta is described as agni (fire) since it performs fire like action i.e paakawhich refers to pachana (digestion), dahana (burning, combustion or oxidation) includingbhinna sanghata (splitting) tapana (heat production) parinamana 9(conversion) paravrithi10 (transformation) prakarshana (illumination) ranjana or varnakara and prabhakara (to causeluster). Kaya is derived from dhatu ‘chinchayani’ means to collect the collection refers to food“chiyate annadibhih”. Kaya takes in food digest, absorbs and utilizes in development of the body. Kaya means building up of body with food. “Kayasya Antharagni Chikitsa kaya chikitsa” – Chakrapani states that kayachikitsa isthe chikitsa of Antaragni.11Clinical study of the effect of Amrita Manjari and Erandabrista Haritaki in the management of Amavata 22
  23. 23. According to Bhoj Kayati Shabdam Karoteeti kayo Jatharagni. Kayachikitsa refers totreatment of diseases, diseases are due to impaired agni. In the entity of the disease ‘Amavata’ Ama and Vata are the most prime factors. Theconcept of ama is mainly based on the concept of agni. Hence agni mandya plays keyrole inproducing Ama where the concept of Agni is a physiological approach, the concept of ama ispathological one. In the skeleton of Dosha-Dhatu-Mala theory the functions of agni are attributed topittadosha. Since the term pitta derived from ‘tap santapa’ similar to Agni i.e agni guna shabdenoshmaa kathyate.12 Pitta is a factor, which regulates all thermodynamic, chemodynamic activities in thebody. Charaka has recorded Marichi as having stated that it is only agni which is located inpitta that gives rise to beneficial or adverse consequences in normal and abnormal state offunctioning condition of initiation and normalcy respectively.13 Chakrapani has observed that this term does not mean pitta is not fire but it is heatassociated with fire, implies that heat is function of pitta. 14 Thus the function of pitta is digestion of food and transformation into various structuraland functional factors of the body. Agni and pitta are possessing moieties of agni mahabhuta and causing dahanapachanaadi karmas and also have similar response to sheetala, ushna prakriyas. Dalhana in his nibanda sangraha has given several references in quoting dissimilarinstances.Clinical study of the effect of Amrita Manjari and Erandabrista Haritaki in the management of Amavata 23
  24. 24. Similarities Agni pitta Tejas tejas Dahana Daha Pachana Paaka Ushna UshmaDissimilarities:Influence of factors Agni pitta Sushka Drava Rooksha Snigdha Only pakadi karamas Other dhee, dhruti karmas in addition to pakadi karmas Maintainence of digestion & Body maintainence apart from metabolism digestion & metabolismGhrita Agni vriddhi Pitta samakaAjaksheera Agni vriddhi Pitta samakaMatsyam Agni mandakara Pitta vriddhikaraDivaswapna Samana VridhikaraGoverned by Pitta and other factors On its own In Ayurveda, kayagni is divided into three as jatharagni which looks after the functionsof food digestion and absorption. Bhootagni which turns all the vijateeya panchabhouticdravyas consumed to sajateeya panchaboutic dravyas i.e conversion of heterogenous tohomogenuous and dhatwagni for the purpose of synthesis and breakdown of tissue. According to Charaka samhita with its commentary by Chakrapani Dutta the number ofagnis enumerated is over 13 as Antharagni 1, Bhutagni 5, Dhatwagni 7. 15Clinical study of the effect of Amrita Manjari and Erandabrista Haritaki in the management of Amavata 24
  25. 25. Susruta attributed the function of agni to pitta and labelled them as Pachakaagni,Bhrajakagni, Sadhakagni, Ranjakagni and Alochakagni looking after digestion, skin color,heart, haemopoiesis and vision respectively.16Vagbhata is seen to have reckoned. 5 Pittas 5 Bhutagnis 7 Dhatwagni 3 Doshagni 3 Malagni in all 23 Agni.17 Further Arunadatta quoted 500 mamsagni, 700 snayuagni and according to doshas 18enumerated upto 1500 and 2100. 19 Sarangadhara is seen to have recognized five pittas only. Bhavamishra is seen to havefollowed Charaka and Vagbhatta.20 However classification of agni for the purpose of praticalutility can be made as follows: 1) Physiological aspects 2) Pathological Aspects 1) Physiological – 1. Jatharagni (1) 2. Bhootagni (5) Prithvi, Ap, Tejo, Vayu, Akasha 3. Dhatwagni (7) Rasagni, Raktagni, Mamsagni, Medoagni, Asthyagni,Majjaagni, Sukraagni. 2) Pathological – with the influence of doshas agni has been classified into four varieties. 1. Sama – Sama dosha gives rise to sama agni 2. Teekshna – under influence of pittadosha, agni becomes Teekshnagni 3. Manda – under influence of Kaphadosha, agni attains Mandagni 4. Vishama – under influence of Vatadosha, agni becomes VishamagniClinical study of the effect of Amrita Manjari and Erandabrista Haritaki in the management of Amavata 25
  26. 26. Jatharagni: Jatharagni means agni which is located in Jathara, amasaya or annavahasrotas.This agni is also called Audaryagni, Kosthagni, Antaragni, Kayagni.Jatharagni is the agni which is located in the gastrointestinal tract and makes the pachana ofchaturvida annapana, sara kitta vibhajana and leading to the production of dosha, rasa, mootra, 21pureesha in this process. According to Charaka koshtagni is the leader of factors concerned withdigestion in the body of all living beings. The activities of all these factors- normal andabnormal are derived from the dependent upon an increase or decrease on the case may be ofJatharagni.22 The seat of agni is (Amapakvashaya madhyagam) Ibid in the region above thenabhi known as Grahani because it receives and retains the food upto the digestion. Grahani isa tubular organ located above umbilicus and being organic site for functional Jatharagni it 23delivers all the functions of it. It holds the apaka ahara as soon as it gets pakwa it deliverspakwahara to its left side to the latter part.23 According to Vagbhatta in his Astanga hridaya and Sangraha, the pitta locatedbetween pakwashaya and Amasaya is panchabhoutika and a dravya inspite of which itperforms action similar to anala due to the accession of the tejas component over the remainingnumber of panchamaha bhoota that compose it. In the chapter doshadi vignaniya of his sangraha, Vagbhata has stated that adecrease or increase of dhatu, occur according to the teekshnata or mandyata of the aspects ofpachakagni present in the dhatu.24 “As the flame of a forest fire tends to increase or decrease according as the quantity of indhana available in its proximity, so also is the case with ‘dhatu parampara’.” Dravyas are either tulya (homologus) or vishista (heterologus) to the dhatus,which cause an increase or decrease respectively of the dhatus due to properities inherited byand potentially present in them.Clinical study of the effect of Amrita Manjari and Erandabrista Haritaki in the management of Amavata 26
  27. 27. Again in Astanga hridaya, he has summed up the earlier sangraha versionquoted above in the following term: moieties of kayagni which located in its own place, aredistributed to and permeate through all the dhatus; a decrease of it makes for an increase ofdhatu.25 In the sangraha he has directly correlated the Pachakagni to dhatwagni and 26dhatupaka. Charaka has made a pointed reference to the madhura and amla aspect ofdigestion in the amashaya, corresponding to starch and protein digestion respectively in thestomach. Samanavata is located near the site of agni. It stimulates and nourishes the agni. In living beings the agni is one among the 12 pranas. Its main function is paaka.Among the five pitas, pachaka pitta can be taken as pachakagni owing to their commonfunctions, qualities and origin.Other activities of Agni: - Ayu (longevity), Upachaya (Anabolic activities), Varna (complexion), Bala(Strength), Swastya (Health), Utsaha (Enthusiasm), Tejas (spirit), Prabha (splendour), Ojas.Bhootagni: - “Deho hyahaarasambhavah” The body is made up of food, in the sense, all the elemental factors required formaintainence and growth of this body is depending upon the same received from externalatmosphere i.e food, air etc. In a nutshell this panchabhoutika sareera is to be maintained andnourished with pancha bhoutikaamsas. To convert such alienamshas, as part of the body thereexists processs of paaka, which is attributed to bhootagni. So all the oxygenous substancesmust be subjected to bhootagni paaka to become endogenous.27Clinical study of the effect of Amrita Manjari and Erandabrista Haritaki in the management of Amavata 27
  28. 28. As such essential aminoacids, essential fattyacids, and essential vitamins areexogenous factors supplemented through food that ignites the enzymatic activity andcompletes metabolism and in the process they become part of the body. Both Charaka and Vagbhata have made direct reference to bhootagni paka,while Susruta has made a mention of it. The outcome of Jatharagnipaka is the bhinnasanghataor the splitting of a complex food substances into their ultimate elemental units or molecules orinto five physico chemical groups i.e parthiva, apya, tejas, vayavya, nabhasa. Jatharagni isstated to ignite the agni present in each of groups. The bhootagni amshas are existing in the body or supplemented through thefood and external atmosphere to augment its own moieties existing in the body to becomeendogenous or saatmya to the sareera. Vaghbhata in his sangraha and hridaya has clearly described that separation ofsara from kitta takes place after composition of bhutagni paka. Bhootagni function starts immediately after absorption i.e portal circulation toliver and ends before assimilation by delivering asthayi dhatwamshas into the circulationthrough the hepatic vein. So the bhootagni functions are carried in the portal system liver and in vascularsystem through which ahara rasa is circulated in the body for nourishing the rasadi saptadhatus. Hence liver is onsidered as center of bhootagni vyapara. As the food consumed are foreign to the body i.e vijateeya and unless they aresuitably processed they may not be converted as specific organism i.e sajateeya substances.This can be illustrated with the example of starches, fats and proteins or panchabhutacomponents of food which by the process of digestion are converted into carbohydrate, fatsand proteins of the body.Clinical study of the effect of Amrita Manjari and Erandabrista Haritaki in the management of Amavata 28
  29. 29. Dhatwagni: - Dhatwagni are seven in number corresponding to seven dhatus. They areRasagni, Raktagni, Mamsagni, Medoagni, Asthyagni, Majjagni and Sukragni. 28 Dhatwagnis are located in its own tissues according to its own srotas either to 29form new tissues or to deliver its functions. Hence if dhatwagnis gets more vridhi tissuedelivers more action and there by more catabolic activity or if dhatwagni is of low profile onlytissue synthesis takes place resulting in dhatu vriddhi.30 These are called as pachakamsas byVagbhata. 31 After digestion, absorption and completion of bhootagnipaka aadya ahara rasacirculates in the body to reach all the tissues and are subjected to its own dhatwagni to formtulya dhatu. Charaka says that sarakitta vibhajana takes palce after dhatwagni paaka only 32and are supplied to respective dhatus. In Vividhasitapitiya of sutrasthana Charaka samhita, Charaka has said that foodingested in four-fold manner first subjected to jataragni paka and then to bhootagni paka,which is ignited by jataragni paka only and again subjected to dhatwagni paka. The end product of Bhutagni pakas are known as poshaka dravyas viz parthivaposhaka dravyas, apya poshaka dravyas, agneya poshaka dravyas, vayavya poshaka dravyasand nabhasa poshaka dravyas. 33 Dhatwagni has 2 aspects 1) prasada paka 2) kitta pakaThe final product of prasada paka are then transferred and transformed to shareera dhatuthrough their respective srotamsi. The end product of kitta paka are various excretions.Clinical study of the effect of Amrita Manjari and Erandabrista Haritaki in the management of Amavata 29
  30. 30. Dalhana says dhatu paka takes place in 3 aspects i.e 1) Sthula or sthayi dhatus 2) Mala 3)Sukshma Dhatu for nutrition of further dhatu. Agni pathologically classified into 3 varieties namely vishamagni, teekshnagni 34and mandagni according to dusti of vata, pitta, kapha respectively. Pranavata, Samanavata and Apanavata has got pivotal role in regulation of gastrointestinal tract, more so samanavata in relation to Jatharagni. The entire movement of food from mouth to amashaya is due to the action ofpranavata.35The function of pranavata includes secretions and splitting of saliva, eructation anddeglutition. Samanavata is present near agni and it always moves throughout the koshta. It is enablethe reception, digestion, separation and propulsion of food. 36 Role of apanavata in aharapachana kriya is limited to sakrit nishkramana only. The bhootagni and dhatwagni are partly regulated by samanavata in intermediarymetabolism since it innervates and controls the pancreas and adrenal medulla. Thus pachakagni influences the bhootagni and dhatwagni accordingly. *******Clinical study of the effect of Amrita Manjari and Erandabrista Haritaki in the management of Amavata 30
  31. 31. References: 1.Shabda kalpa druma, part 1, page no 180 2.Chakrapani – Ayurveda Deepika Commentary On Charakasamhita 15th Chapter 13th Sloka 3.Susruta – Susruta Samhita, Sutra Sthana 21st chapter 10th Sloka 4.Charaka – Charaka Samhita, Chikitsa Sthana, 15th Chapter 3-4 Sloka 5.Susruta - Susruta Samhita, Sutra Sthana 21st Chapter 5th sloka 6.Tapa Santhape - Susruta Samhita, Sutra Sthana 21 st Chapter 5th sloka 7.Tapa aiswarye – Divadiguna(Tapyate) Tapadahe - ………Eurvadi gana (Tapayati tapayate) Tapasantape - ………Bhavadigana (Tapati) 8.Tapyate astavidharmanamadi kamiti pitta Taapayati daahati bhukthamaharaajatham eeti pittam/ Tapati ushmana mamutpadayateeti pittam 9.Paakah parinatou (Medini)10.Paakah Paravriti (Medini)11.Kayasyantargne chikitsa kayachikitsa - chakrapani datta12.Dalhana Nibandha sangraha commentary on Susruta Samhita, Sutra Sthana 21 st chapter 9th sloka13.Charaka Samhita, Sutra Sthana 12/1114.Chakrapani on. Charaka Samhita, Sutra Sthana 12/11 th th15.Charaka Samhita, Chikitsa Sthana, 15 Chapter 38 sloka st th16.Susruta - Susruta Samhita, Sutra Sthana 21 Chapter 10 sloka 17.AstangaHridaya, Sootra Sthana 12 and Sareera 318.Aruna datta – Sarvanga sundara commentary on Astanga Hridaya, Sootra Sthana 12 th chapter19. Sarangadhara Samhita, Poorvakhanda 5th chapter20. Bhavaprakasha prathamakanda, sareerasthana 3rd chapter st th21.Susruta - Susruta Samhita, Sutra Sthana 21 Chapter 10 sloka th th22.Charaka Samhita, Chikitsa Sthana, 15 Chapter 39 sloka23.Ibid sloka 38 - 41,56,5724.Astanga Hridaya, Sootra Sthana 9/1, Susruta Samhita, Sutra Sthana 46/526Clinical study of the effect of Amrita Manjari and Erandabrista Haritaki in the management of Amavata 31
  32. 32. 25.Astanga Hridaya, Sootra Sthana 11/3426.Astanga sangraha Sootra Sthana 19/26 – 2827.Charaka Samhita, Chikitsa Sthana, 15 th Chapter 13th sloka28.Charaka Samhita, Chikitsa Sthana, 8th chapter 39th sloka29.Astanga sangraha Sootra Sthana 19/26 – 2830.Astanga Hridaya, Sootra Sthana 11/3431.Astanga sangraha Sootra Sthana 19/26 – 2832.Charaka Samhita, Chikitsa Sthana 15th chapter 15th sloka33.Astanga hridaya sareera 3/64.34.Susruta - Susruta Samhita, Sutra Sthana 35th Chapter 24 th sloka35.Susruta - Susruta Samhita, nidana sthana 1 st chapter 13th sloka th th36.Charaka Samhita, Chikitsa Sthana 28 chapter 6 sloka. *******Clinical study of the effect of Amrita Manjari and Erandabrista Haritaki in the management of Amavata 32
  33. 33. Clinical study of the effect of Amrita Manjari and Erandabrista Haritaki in the management of Amavata 33
  34. 34. CONCEPT OF AMA The word Ama is derived from ‘Aamyate ischat pachyate’(Vachaspatyam) whichindicates that which undergone slight ‘paka’. Paka means “paakasha agni samyogath kala 1visheshah. The word Ama has also got meaning of ‘Ischatpakwa’, ‘Asidha’, ‘Pakarahita’,‘Apakwam’, ‘Vyasthatam’2 etc., Ishatpakwa means that which undergone slight paka, Asidhi means not attained finalform i.e siddhi. ‘Pakarahita’ that which is not at all undergone paka. ‘Apakwam’ i.e. notcooked. Finally the word ‘Ama’ can be defined as a substance, which is not involved in theprocess of paka without attaining its final form. The term ‘Ama’ in general sense means unripe, uncooked, immature and undigested.3 According to Vagbhata due to the hypofuntioning of Ushma (agni), the first dhatu vizthe rasa or chyle, is not properly formed. Instead, the annarasa undergoes fermentation and or 4putrefaction (dusta) being retained in amashaya. This state of rasa, which is spoken as Ama. Ama is defined as “aharasya rasah saarah yonapakwo agnilaghavath”. 5 In this sloka of Vagbhata ‘Dhatumadyam apachitam’ is to be taken as ahara rasa whichis first to all saptadhatus but not rasadhatu, since it does not undergo rasagni paka at that level,the same was quoted by Dalhana on Susruta sutra15th chapter. 6 Charaka says “the undigested food which resulted due to various causes of mandagni,attain suktatwa (fermentation) leading to set of toxic states called as Amavisha”. 7 Susrutha further adds “Vranapaakabhave” i.e vrana until it gets paripakwa state iscalled as Ama condition temporarily. 8Clinical study of the effect of Amrita Manjari and Erandabrista Haritaki in the management of Amavata 34
  35. 35. Vijayarakshita has cited a number of definitions and descriptions of amadosha asfollows:” the ahara which is not properly digested and stagnated, then the outcome of richdigestion is known as Ama”. 9 The annarasa, which is not properly formed in amashaya due to the impairment of 10kayagni, is known as Ama. The indigested annarasa possessing odour with high viscosity causing gatra shastilyatais known as Ama. 11 Imperfectly digested intestinal contents are known as Ama.12 Residual ahara rasa after absorption at the end of digestion process in amashaya is 13known as rasaseshi, which is also called as Ama. The first stage or phase of Dosha dusti or dosha dooshya sammurchana is also called asamavastha.14 In Shabda kalpa druma one more is added, stating that ‘Ama is the factor in causation 15of shatprakara ajeernas’. Sarangadhara says ‘the samyak pakwa ahara rasa’ is called as rasa and ‘the apakwaahararasa’ as Ama.16 Ama is a stage/condition of a substance resulted in the process of paaka on subjectingto the agni, before attaining its final transformation in the sense, the ingested material to betransformed either to yield energy in the body (for dhatu vyapara) or for synthesis, of newtissue (dhatu nirmana) and final elimination as end products. Once the substance attains the target state i.e. avashta/form/sidhi it is not called asAma. Simply it can be said, as ‘Ama is the precursor state of a substance in transformation’.Clinical study of the effect of Amrita Manjari and Erandabrista Haritaki in the management of Amavata 35
  36. 36. Ama condition can be formed at any level of agni sannikarsha due to its hypofunctioning maybe at jatharagni, bhootagni and dhatwagni. Further, the initial stage of vitiated doshas or first phase of dosha dushya sammur chana 17is called as a state of ama dosha. Apakwa ahara rasa is different from amarasa, which makes difference between ajeernaand ama conditions.The apakwa ahara rasa which is situated in amasaya gets shuktatwa afterpassage of some time, that sukta bhava of apakwa ahara rasa is called ama. During furthercourse of time, the ama interacts with doshas and become pathogenic which is known asamadosha. 18 This amadosha on further stasis gets more suktatwa there by attains & acquires ‘visha’ 19qualities, this toxic condition is known as Amavisha’. Hence Ama, Amadosha and Amavisha terms are distinct indicating the actual state ofAma.Ama Swaroopa: Ama is as state of a substance resulting in the process of paaka before attaining finalityi.e. Ama is a pathological qualitative change in a substance during the process of paaka may beat Jatharagni, bhootagni or at dhatwagni level.20 If a substance attains certain pathological qualities without attaining finality such 21substance is called as Ama dravya and its existing swaroopa is Ama swaroopa. Gunas of Ama are drava, guru, snigdha, pischilata, tantum, avipakwam, asamyuktam,durgandam, abhishyandi, srotoavarodha, katu amla rasas, suktata. 22Clinical study of the effect of Amrita Manjari and Erandabrista Haritaki in the management of Amavata 36
  37. 37. If ama continues in the state of asamyukta for longer periods without elimination, itattains suktata in which the generation of amagunas or visha gunas i.e. toxic condition takesplace and become endanger to life called as Amavisha condition. So at the level of amavisha amaswaroopa or gunas are similar to that of visha gunas. The color of ama as described by Vagbhata “aneka varna” may be due to the substanceunder process and the tissue involved, hence various colors of amadravya are seen.Ama nidana (Etiological factors): Ama is formed due to disturbance of agni, any factor which disturbs the agni directly orindirectly is the cause for the production of ama. Out of these pathological conditions of agni except teekshnagni remaining two i.emandagni and vishamagni are the prime causes of ama but ultimate is mandagni condition.Hence all the causes whether they are primary or secondary leading to mandagni are thecausative factors for production of ama. All factors basically can be classified into two types 1) Primary 2) Secondary Primary are those, which are having direct influence on agni leading to mandagni thereby amotpathi. Secondary are the causes, which triggers the doshas first, there by affecting the agnileading to mandyata in turn amotpatti.Clinical study of the effect of Amrita Manjari and Erandabrista Haritaki in the management of Amavata 37
  38. 38. Primary Causes: These are the causes having direct influence on Agni to diminish its functions 1) a) Dietetic indescretions 231. Anasana, adyasana, ajeernakara ahara, virudhaahara, asaatmyahara sevana, guru aharasevana, sheetala ahara sevana, dry, dehydrated food, putrid food intake, apriya padarthasevana, vistabda ahara sevana, vidagdha ahara sevana, apakwa ahara, adhika jalayukta aharasevana, vishamasana, dried fish, certain varieties of fish, heavy meats like beef, sheep, pork etcdiet saturated with tubors, pista padarthas, creams, viscid substancesatimadhura, amla rasa sevana.b) Dietic incompatibilities1 desha, kala, agni, matra, satmya, vataadi dosha, samskara, veerya, koshta, avasthakrama,parihara, upachara, paaka samyoga, hrith, sampada vidhi virudhani.2) Adverse effects of shodhana therpaies specially Vamana, virechana, vasti including snehaswedas.3) vega sandharana – sadaaturas4) Viruddha cheste ajeerna vyayame, ajeerna vyavaya, ajeerna jala pratarana, exerciseimmediately after snigdha ahara sevana.5) Unhygenic conditions and not following ahara vidhi vishesha aytanas.6) Nischalatwa or avyayama- sedentary habits.7) Manasika vikara – Mental tensions and emotional instabilities i.e kama, krodha, asuya etc.8) Kapha,Pitta vardhaka ahara vihara sevana.Clinical study of the effect of Amrita Manjari and Erandabrista Haritaki in the management of Amavata 38
  39. 39. Indirect Causes:  Any disorders leading to agni mandyata at various levels of agni.  Any disorders leading to emaciation  All kaphaja vikaras  All pittaja vikaras  All the causes, which trigger the doshas first, they’re by leading to agni mandyata and amotpatti.Diseases like madhumeha, vatarakta,raktapitta,sthoulya,udara,kshaya, amavata and severalother disorders are due to hypofunction of agni.Flow Chart: Apakwa ahara rasa Getting suktata on stasis Amarasa _____Phase 1(Initial phase) On further stasis Amadosha _____Phase 2(Intermediary phase) getting more suktata on further stasis Ama visha ______ Phase 3 (final phase)Formation of Ama rasa,Amadosha, Amavisha in course of time.Clinical study of the effect of Amrita Manjari and Erandabrista Haritaki in the management of Amavata 39
  40. 40. Pathogencity of Ama in Gastro intestinal tract:S.No Location of Ama Pathological Condition1. Apakwa ahara in Amasaya Hrillasa, chardi, Amlapitta2. Apakwa ahara rasa in amasaya Hrillasa, Chardi3. Rasaseshi Hrillasa, amlapitta, chardi, ajeerna lakshana4. Saama ahara rasa According to triggering of samanavata and pachakapitta. Inhibition of samanavata functions results in adhmana, anaha, dandalasaka, alasaka.5. Apakwa mala Atisara, visuchika,alasaka, dandalasakaPathogencity of Sookshma ama rasa in circulation:S.No The location of Ama Pathological Condition1. Adhidhatu (ahara rasa in circulation) Anaphylactic shock, allergic manifestation seethapitta, manda, kotha, jwara, angamarda, aruchi, alasya, tandra etc.Clinical study of the effect of Amrita Manjari and Erandabrista Haritaki in the management of Amavata 40
  41. 41. Pathogencity of sookshma ama rasa in circulation (at various dhatu level)S.No Location of Sookshma Pathological Conditions ama rasa1. Rasa dhatu Jwara, tamka swasa, amavata,seetthapitta, tandra, alasya, arati, klama.2. Rakta dhatu Pandu, kamala, arumshika, vidradhi raktapitta (hemolytic disorders) haemoghobinopathies, thalassemia, kustha, visarpa etc. Grandhi, apachi, arbuda, pidaka, adhimamsa, myopathies, pseudomuscular dystrophies, atrophies, organomegalia conditions.3 Medho dhatu Sthoulya, atisweda, dourgandhya, hyper lipo protienamea, xerosis, xanthomas, atherosclerosis, hypo lipo proteinameia4 Asthi dhatu Irregular bony growths, osteopathies, osteomylieties.5 Majja dhatu Akshisneha, vitsneha, angamardha, madhumeha6 Sukra dhatu Inhibited growth, klaibya, loss of immunity, immuno deficiency disorders, azoospermia,oligospermia, disturbed spermatogenesis, sukra doshas. *******Clinical study of the effect of Amrita Manjari and Erandabrista Haritaki in the management of Amavata 41
  42. 42. References:1,3. Vachaspathi Misra: Vachaspathyam2. Raja Radhakantha Deva: Shabdha kalpadruma part 1 Chowkamba Sanskrit series office, Varanasi page 180 th4. Vagbhata Astanga hridaya, Sutra sthana 13 chapter, sloka 25, Chowkamba orientations th Varanasi, 9 edition 2002 Page 2165. Madhavakara, Madhavanidana, Chowkamba orientation Varanasi page 4606. Dalhana – Nibanda Sangraha, Susruta – Susruta samhita sutra sthana 15 th chapter chowkamba orientation Varanasi 1992 5th edition page 73.7. Charaka – Charaka Samhita chikitsa sthana 15th chapter sloka 44 nirnaya sagar press Bombay page 5178. Vachaspathimishra – Vachaspathyam 9-14- Vijayaraksheeta- Madhukosha commentary on soka 1 to 5, Amavata nidanaMadhavanidana edited by Madhavakara, Chowkamba orientation Varanasi page no 460 15. Rajaradhakantha deva – Shabdhakalpadruma part 1 chowkamba Sanskrit series officeVaranasi page 18016. Sarangadara – Sarangadarasamhita purva kanda 6th chapter sloka 8, baidyanath ayurveda nd ltd nagpur 1974 2 edition page 115 rd17. Concept of ama in Ayurveda by M srinivasulu 3 chapter chowkamba Sanskrit series office Varanasi page no 26 18. Vijayaraksheeta – Madhukosha commentary on sloka 1 t o5 Amavatanidana Madhavanidanaedited by Madhavakara chowkamba orientalia Varanasi page 46119. Vagbhata Astanga hridaya sturasthana 8 th chapter sloka 4 chowkamba oreintalia Varanasi 9th edition 2002 page 14820,21 Concept of ama in ayurveda by Dr M Srinivasulu chapter 3 rd page 28 chowkamba orientation series office Varanasi th22 a) Vagbhata Astanga Hridaya sutrasthana 13 chapter sloka 18 chowkamba orientalia th Varanasi 9 edition 2002 page 214 b) Vijayaraksheeta Madhukosha commentary on sloka 1 to 5 Amavata nidana Madhavanidam edited by Madhavakara chowkamba orientalie Varanasi page 461 *******Clinical study of the effect of Amrita Manjari and Erandabrista Haritaki in the management of Amavata 42
  43. 43. Clinical study of the effect of Amrita Manjari and Erandabrista Haritaki in the management of Amavata 43
  44. 44. NIDANA Amavata, word consists of two words viz Ama and Vata, ‘Amena sahitah vatahamavatah’ 1. It means in Amavata, Vata is associated with Ama so its main two causativefactors i.e. Ama and Vata are prime in manifestation of the disease. Therefore all causes forAmotpathi associated with vata prakopa as mentioned in Ayurvedic classics may be consideredas Nidana of Amavata. So, the causes of Amavata can be studied under two headings:  Indirect or Non-specific Causes  Direct or Specific CausesIndirect or Non-specific Causes: These are causative factors for Amotpathi and Vata prakopa separately which inturncauses the Amavata. a) Causes for Amotpathi: - These causes are described in detail in Chapter Concept of Ama while dealing with thecauses for production of Ama. These causes produce mandagni, which leads to Ama conditionand in prescence of deepthagni also, Amotpathi may takes place due to Adyasana sheelatvam 2.Which is one of the most important internal causes for Amavata. 3 b) Causes for Vataprakopa : - The causes of Vata prakopa are as follows: - c) 1. Ahara nidana: - 1. Constant consuming of laghu, rooksha, sheetaguna, suskha ahara 2. Nirantara alpa ahara sevana 3. Vishama pachara i.e irregular intake of foods 4. Adyasana 5. Constant consuming of Kashaya, Katu, Tikta sevana 6. Intake of varaka, uddalaka, koradusha, syamaka, nivara, mudga, masura, adhaki, harenu, kalaya nishpava (different varieties of cereals and legumes. 7. Langhana viz. Upavasa, Anasana.Clinical study of the effect of Amrita Manjari and Erandabrista Haritaki in the management of Amavata 44
  45. 45. 2. Vihara 1. Athi Vyayama - excessive physical exercise 2. Athivyavaya - excessive intercourse 3. Adhyanana - excessive learning activities 4. Prapathana - falling from heights 5. Pradhavana - excessive running 6. Prapidana - excessive massaging, pressing 7. Plavana - hopping 8. Pratharana - swimming 9. Ratri jagarana - wakefulness at nights 10.Bharaharana - carrying heavy loads 11.Gaja turaga radha aticharya - excessive elephant or horse riding 12. Padathi Charya - excessive walking 13. Vega dharana - suppression of urges like katus, urine, feaces, semen, vomiting, sneezing, belching and tears. 3. Dhatu Kshaya4 4. Amarasa4 5. Manasika Vikaras5 such as chinta - Anxiety Moha - Confusion Shoka - Grief Eershya - Envy Krodha - Anger Dukkha - Unhappiness Bhaya - Fear Mana - Pride, ego Kama - Passion Udvega - Anxiety Lobha - Greed Hree - Bastifulness 6. Abhighata viz marmabhighata, seegrayamopatamsana4. 7. Anya karana: - 1. Adverse effects of Panchakarma therapy such as  Vamana  Virechana  Vasti including secant swedana6Clinical study of the effect of Amrita Manjari and Erandabrista Haritaki in the management of Amavata 45
  46. 46. 2. Vyadhi karshanat (emaciation due to diseases) 73. Krimi doshas 8Direct or Specific Causes: - 9 The specific causes for Amavata as per mentioned in Ayurvedic classics  Viruddha ahara  Viruddha chesta  Mandaagni  Nischalatwa  Snigdhabhukta vat vyayamam (exercise immediately after snigdha ahara sevana)  Diet saturated with Kandha sakas.10Viruddha Ahara: - Viruddha Ahara is considered as a major etiological factor for various morbidities inAyurveda. It is specified as the substance, which vitiates the dosha but does not eliminate themout of the body. It also remains in the body even when it is unfavourable to he dhatus. 11 Thusthe substances having characteristics opposite to dhatus become vairodhika or incompatible to 12it. (Ca, Su, 26.81) Acharya Charaka has described eighteen types of Viruddhahara ( Charaka Sutra Sthana26/86-87) causing vitiation of Agni which leads to production of Ama. Although all the threedoshas are vitiated by intake of viruddhahara but involvement of other vata vitiating nidanascauses the predominance of vata when gets accompanied with ama eventually causes Amavata. Charaka mentioned the disease Amavisha as one of the virudhaahara sevana janyarogas13.Particulars of Virudha ahara (C.C.26)Clinical study of the effect of Amrita Manjari and Erandabrista Haritaki in the management of Amavata 46
  47. 47. Paraspara guna virudha: -Milk - fish (specially chilichimum with milk produces ama visha)Milk - Amra, amrataka, matulunga, badra, koshamra, bhavya, jambava, panasa, nikuchi, karmarda, mocha, dantasata, kapita, thinthidika, paravata, Akshoda,narikela, danima, amalaka other substances which contain amla rasa. a) Samyoga virudhani  Gramya mamsam, Anupa mamsa, Audaka mamsa - madhu, tila, guda, dugda, masha, muli and germinating seeds  Padmoktarika sakam - sarkara, myreya,madhu  Hareela pakshi - Sarshapa taila  Payasa - Manthanupana  Upodika - Tilakalka  Mayura mamsa - Eranda  Haridraka mamsa - HaridraAdding in equal quantities: -  Madhu - Ghee  Madhu - Akashajala  Madhu - Pushkara bheeja  Taking hot water while taking madhu  Taking ballataka with hot water  Takra prepared with kampillaka c) Samskara virudhani  Frying of pouskar and rohini shakas in sarshapa tail  Frying of kapotha mamsa in madhu and dugdha  Boiled honey d) Kala virudhani – Taking milk immediately after ingesting mooli, Krishna gandha, arjaka, sumukha and sarasa. Factors responsible for dietetic Incompatibilities: -  Desha virudhani  Parihara virudha ahara  Krama virudhani  Agni virudhani  Kala virudhani  Upachara virudha aharaClinical study of the effect of Amrita Manjari and Erandabrista Haritaki in the management of Amavata 47
  48. 48.  Mathra virudhani  Samskara virudhani  Paka virudha ahara  Sampada viruddha ahara  Veerya virudhani  Vatadidosha  Samyoga virudha ahara  Vidhi viruddha ahara  Kosta virudhani  Avastha virudhani  Hrit viruddha ahara  Satmya viruddhani 2) Virudha Chesta: -These are 1) Ajeerna vyayama 2) Ajeerna vyavaya 3) Ajeerna jala prataranadi.These are the causes for vitiation of Agni and leads to production of Ama. These are alsothe causes for vitiation of Vata. Both factors when combined produce Amavata. 2) Mandagni: -This is the most important factor in production of the disease Amavata what ever may bethe other causes; they should cause mandagni through which Amavata is the result. Itplays a vital role in production of Ama and Amavata. The causes leading to mandagnihave been already described in this chapter. 4) Nischalatwa: -The sedentary habit (Nischala) is responsible for agnimandya as well as for heenayoga ofkaremendriyas, which are ultimate sufferers in the disease process. 5) Snigdhabhuktavata annam vyayamam (exercise immediately aftersnigdha ahara): - It is advised in swasthavritha to take some rest after meals for the better digestionand to keep the doshas in some position. If proper rest is not taken after snigdha aharaand doing exercise immediately vitiates the vatadosha(samana) which inturn disturbs thepachakagni. Then it will not able to digest the ingested ahara, which may result into Amaleading to Amavata.Clinical study of the effect of Amrita Manjari and Erandabrista Haritaki in the management of 48Amavata
  49. 49. 6) Diet saturated with kandha shakas: - Hareeta Samhita mentions this cause only. Naturally kanda shakas consists ofmore guru, snigdha gunas and madhura rasas, which becomes heavy for jatharagni andthese, may play a role in causing the disease as srota abhishyandakaras. But all these causes come under the causes leading to mandagni. After all,while summing up that all the causes mentioned above will lead for production of amaand vitiates the vata which inturn produces the disease Amavata. *******Clinical study of the effect of Amrita Manjari and Erandabrista Haritaki in the management of 49Amavata
  50. 50. REFERENCES: 1. Shabdakalpa druma part 1 Raja Radhakanta Deva, Choukhambha Sanskrit series Varanasi th nd 2. Susruta Samhita Sutrasthana 15 Chapter 32 sloka nd 3. Charaka Chikitsa sthana 28/15-19, Madhava nidana 22 4. Susruta samhita sutra sthana 21/19, charaka chikitsa sthana 28/15-19 5. Charaka samhita vimana sthana 2/8-9 6. Charaka samhita chikitsa sthana 15/43-44 7. Charaka samhita chikitsa sthana 15/43-44 8. Susruta uttara tantra 40/3-5 9. Madhava nidana Amavata nidana chapter 25 10. Hareeta Samhita chapter 21 11. Astanga Sangraha Sutrasthana 9/25 12. Charaka Samhita Sutrasthana 26/81 13. Charaka Samhita Sutrasthana 26/102 14. Madhava nidana Amavata nidana 25th chapter Madhukosha. *******Clinical study of the effect of Amrita Manjari and Erandabrista Haritaki in the management of 50Amavata
  51. 51. SAMPRAPTI The production of ama takes place due to the factors mentioned in nidana. Theamarasa is carried to sleshma sthanas by vitiated vata i.e. to amashaya, sandhi, hridayaetc. 1 Ama travels to sleshma sthanas because it is having affinity to its own gunas(snigdadi). In sleshma sthanas ama again gets paka or vidagda or vitiation by prakupitavata. Until this stage, ama is at sleshma sthanas but after getting vitiation by vata, itenters into the circulation through dhamani. Now the amarasa circulated, spreads all overthe body and to all organs. As the ama having bahupicchalatwa and srotoprathibandakatvam or abhisyanda kara gunas, it causes sroto prathi bandakatwam orobstruction to the free flow of doshas, by that the avarodha tridoshas gets prakopa, againvitiates the amarasa. At this stage, the amarasa gets nanavarna, atipicchilata by virtue ofvitiation by tridoshas and it will become further too viscid, which is able to causesrot oavarodha and the disease, where ever srotodusti is there, there it will stick due toabhisyandakaratwa and it causes srotoavarodha by result of it so many diseases willoccur. As the rasa is in apakwa dasha, the function of rasa dhatu i.e preenana karma willget lost, by that all dhatus in the body will get starvation of its nutrition as a result‘ashudourbalyam’ takes place. Instead of ‘ashudourbalyam’,Bhava prakasha karadescribed ‘Janayatyagni dourbalyam’ as first manifestation.2 Here agni dourbalyamsuggests the dhatwagni dourbalyam .As the rasa circulated to the dhatus, the dhatwagnismay get dourbalya which causes the production of ama. Mandagni produces ama, amaproduces Mandagni. It is having a link of mutual contribution, which helps each other ina cycle for continuation of the disease process. Until this stage, there is no manifestation of any specific clinical feature, butashudourbalyam and hridayagouravam may be treated as poorvaroopas of the disease.The ama having picchalatwa guna and snigdhadi gunas would naturally shows its affinityto the kapha sthana. That is how the joints are effected by Amavata. The gunas or physicoClinical study of the effect of Amrita Manjari and Erandabrista Haritaki in the management of 51Amavata
  52. 52. chemical quality of ama in the circulation enhances the kapha dosha, which leads tokapha prakopa. As already vata is in prakopa avastha, both the prakupitha doshasimmediately attacks or enters the trikasandhi for the manifestation of the disease. 3Trika Sandhi: As Madhavakara mentioned the manifestation of the disease starts fromtrikasandhi. The word Trika means a joint of three substances. “Trayonaam sangah kahtrikam.” 4 Apart from bones, togetherness of three parts also called as trika. Susruthadescribes two trikasandhis where as Dalhana comments on it as Urdhwa trika and adahtrika. Urdhwa trika means a sandhi pradesha of both shoulder and vakksha. 5 Dalhana says 6sandhana sthana of shirah and bahudwayam (Trikam shiro bahudwaya sandhana sthana)while commenting on susrutha 21th chapter. Again Susrutha describes trika as 7kandhabaga of sroni. (Yaddapi sroni kandha bhage trikam prasiddham). In Amarakosha,trika is described as ‘Pristavamsha dare trikam’, in relation to the site of manifestation ofthe Amavata. It appears that the lowest portion of vertebral column i.e trikaasthi sandhimay be consider as trikasandhi. Practically it is seen that the manifestation of the diseasestarts from all the bigger joints. Hence trikasandhi mentioned by the Madhavakara is tobe consider as all the bigger joints i.e wrist, elbow, shoulder, hip, knee, ankle, ilio sacraljoints etc., Thus the manifestation of the clinical features of the disease starts fromtrikasandhi and followed to whole body. These two symptoms are very prominent andimportant, which indicates the severity of the disease. But Madhukosha kara says eitherboth or any one of symptoms of above may present.Clinical study of the effect of Amrita Manjari and Erandabrista Haritaki in the management of 52Amavata
  53. 53. Flow Chart: Samprapthi of Amavata Mandagni  Ajeerna  Ama  Ama anna  Ama rasa Vata Blood Stream Sleshma Sthana (Sites of Kapha i.e sandhi,hridayam etc.) Sroto avarodha AmavataSamprapti Ghatakas:Dosha - Vata, KaphaDushya - RasaAdhistanam - Sandhi,sleshma dhara kalaSrotas - Rasa vaha srotasSroto dusti prakara - SangaAgni - Jataragni, Dhat wagni, BhootagniUdbhava Sthana - Trika SandhiSanchara sthana - All sandhis specially bigger jointsRogamarga - Madyama rogamarga *******Clinical study of the effect of Amrita Manjari and Erandabrista Haritaki in the management of 53Amavata
  54. 54. References: - 1. Madhava nidana 25th chapter 2,3,4 slokas 2. Bhava Prakasa – Amavata prakarna 3. Astanga Hridayam Sutrasthana 12,15 nd 4. Parishadyam sareeram 2 edition 1979, Baidyanath Publication 5. Susrutha samhita chikista sthana chapter 4/18 6. Trikam siro bahudwaya sandhana sthanam-----/Dalhana 7. Susruta samhita sareera sthana 5/16 8. Madhava nidana 25th Chapter 5th sloka. *******Clinical study of the effect of Amrita Manjari and Erandabrista Haritaki in the management of 54Amavata
  55. 55. ROOPA The Roopas of Amavata is of two types: - 1) Samanya lakshanas 2) Pravidhalakshnas. The roopas of Amavata either samanya or ativridhi as described byMadhavakara is appears in all the texts which described Amavata, without any additionor omission except few authors. The samanya lakshanas of Amavata are as follows: -  Angamarda  Aruchi  Trishna  Alasya  Gouravam  Jwara  Apaka  Shoonathanganam 1(M.Ni 25.6)The amavatasya samanya lakshanani may be understood in two aspects. 1) The lakshanas, which are produced at an early or preliminary stage of the disease. 2) The lakshanas, which appears in all the Amavata cases irrespective of dosha predominace or its varieties. If the doshas get more vitiated of pravidha lakshanas may also manifested.Angamarda: - The word Angamarda is made up of Anga+ marda. Anga means Avayava(organs), gaatra (body)(vachaspatyam) and mardana means pain. In Amavata, Ama possesses abhisyandi, pischila, guru etc. that causes srotorodha.Srothorodha causes vata prakopa which results in pain all over the body i.e. Angamarda.Aruchi: - Aruchi means arochka, ashraddha, ananvabhilasha. “Na anne ruchirbhavati”(Shabdakalpadruma)Clinical study of the effect of Amrita Manjari and Erandabrista Haritaki in the management of 55Amavata
  56. 56. When Ama accumulates more at sleshma sthanas – Jihwa or rasendriya thenbodhaka sleshma gets vitiation and loses its function of rasabodhana hence aruchi isnoticed.Trishna: - Trishna means “Peetam peetam hi jalam shoshayastavata na yaaty shama”(Ch.Chi 22/7). It is also known as udanya, pipasa, trit, tarsha, trisha etc. This symptom appearsbecause of circulating fluid viscosity has been increased due to ama gunas, hence tomaintain normal viscosity, PH value and homeostatic. The body craves for more fluidand stimulates the thirst centre in the brain and due to ama sroto avarodha in udhakavahasrotas which leads to trishna.Alasya: “Yah saamarthye apyanutsaaha sthadalasya murdeeryate” (Saranagdhara samhita purva khande 6/67)Means the person who has not zeal or enthusiasm to do any work but he has ability. It isalso known as tandra, mandata, karyapradwesham, so in case of Amavata, the nutrition isdeprived to the tissue due to ama hence the indriyas are not able to perform its function,this condition is known as Alasya.Jwara:“Dehendriya manastaapee sarvarogaagrajo bali”(Ch Chi 3/4)The body temperature is higher than normal, manas and indrias are not in the normal stateto percept their subjects are called Jwara. When Ama is in circulation body temperature raises and keeps it enhanced untilthe Ama gets pachana in the body as defence mechanism. Thus raise of temperaturebecomes an inevitable indication for prescence of Ama.Clinical study of the effect of Amrita Manjari and Erandabrista Haritaki in the management of 56Amavata
  57. 57. Apakah:Paakaa bhava apakah (vachaspatyam)Apakah means Ajeerna. This is due to hypofunctioning of Agni, which is the main causefor the production of Ama in Amavata.Shoonataanganam:The word ‘Shoonatanganaam’ means inflammation, redness, tenderness and swellingover the joints. “Karoti sarujam shotham yatra doshah prapadyata” Whenever the doshas move that swelling also move. Each in acute amavataconditions, few joints swell and give rise to Vrischika vyavida vedana. But disappears onits own, in one day and next morning, another joint gets affected and previous joints getrelieved. This condition of migratory (Bhramanasheelatva), which is almost allpratyatmaka linga of amavata, which is key to differentiate with conditions of vataraktaand sandhivata.Pravridha Lakshanas: - oHasta sandhi vedana and shopha o Daham oPada sandhi vedana and shopha o Bahu mootrata o Sirah sandhi vedana and shopha o Kukshi Shoola o Gulfa sandhi vedana and shopha o Anidra o Trika sandhi vedana and shopha o Trishna o Janu sandhi vedana and shopha o Chardi o Uru sandhi vedana and shopha o Brama o Vrischika damsa vedana o Moorcha o Agni dourbalyam o Hridgraham o Lala prasekam o Vidwibddata o Aruchi o Jadyam o Gouravam o Anthra Koojanam o Utsaha hani o Anaham o VyrasyamClinical study of the effect of Amrita Manjari and Erandabrista Haritaki in the management of 57Amavata
  58. 58. Apart from the above symptoms yogaratnakara added one more symptom i.e grahani dosham. SriVaidya shodal author of gadanigraha described manya, prista, kati sandhi vedana as additionalsymptom to the above. In Basava Rajeeyam, Deham cha Panduram Mutram Trishna, Chardischa netrakam, Pithavarnam bavedhushnam amavata sya lakshanam ( P.No 302 Basavarajeenyam, konda Sankaraiah) In Amavata mostly movable joints are affected, why because the sandhis are sleshma sthanaand ama comes to sleshma sthana which causes swelling of the joints by the guna of ama andprakopitta sleshaka sleshma obstruct the srotamarga of vata which inturn gets prakopa causes severepain i.e sandhi raja. Vrischika damsavat vedana is a localized burning type of pain particularly seen in Amavata.It is throbbing and cutting type. The swelling and pain moves from one joint to another joint as thedosha moves from one place to another place. The manifestation of agni dourbalyam is result of mutual contribution mechanism ofamotpatti and mandagni. Mandagni produces ama, which inturn increases the kapha dosha causesmandagni to become still manda. Again due to mandagni ama production takes place continuously.Hence in samprapti of the disease, it is a continous cycle, which keeps the continuity of the diseaseprocess. In regarding samprapti of the disease, the ama reaches all the sleshma sthana throughcirculation, vitiate the sleshma so kantha pradesha is also bodhaka sleshma sthana due to bodhakasleshma prakopa, praseka i.e hypersalivation is noticed the feeling of heaviness in the body is theresult of guru guna present in Ama, due to vitiation of bodhaka kapha and jihwa is not able toperceive taste, lead to mukha vairasyata. Apart from this due to agni mandyata excess Ama produceswhich coats the jihwa. So the taste buds are not able to perceive the taste of food material, whichleads to vairasyam.Clinical study of the effect of Amrita Manjari and Erandabrista Haritaki in the management of Amavata 58
  59. 59. Bahumootrata means the condition where a patient passes large quantity of urine i.e.polyuria, when ama is more in circulation the body tries to take it off either by way of sweda ormutra. But due to Ama, swedha avarodha takes place, so the sole secreation of malas is to be madethrough urine only resulting in bahumootrata. Kukshi katinyata means rigidly, stiffness due to abhisyandhi, tantumyakta, pischilaguna ofama at the jatara, they stick to the mucosal membrane of colon, will not permit the puresha to movedown ward freely and peristaltic movement will also hamper hence sroto avarodha takes place in thecolon and leading to rigidity i.e. kukshi katinyata.When the ama vitiates vata in the kosta (GI tract) and produces shoola is called Kukshishoola. Theincrease condition of Ama causes vata prakopa leading to sleeplessness during night and in thewhole night as the movements are not made, ama increases and more kapha vriddhi takes placewhich inturn induce sleep in the day. Due to ama, the srotoavarodha takes place in annavahasrotasand vitiates the vata, which causes the reverse peristalsis of the stomach and evacuation of itscontents through the esophagus, mouth result to chardi i.e. vomiting.In the amavata brama, moorcha may be seen when the jwara becomes severe here the prakupithapitta causes brama and moorcha.Hridgraha is due to Ama having sroto abhisyandakara and pischilata guna causes obstruction inhridaya.Vidvibaddhtam is due to vata prakopa, ama which has abhisyandi, bahu pischilata and tantu mayagunas in the koshta will not permit the poorisha to move down freely due to stickness to the mucosalmembrane or the koshta. Due to vataprakopa and ama in the koshta, the intestinal peristalsismovement may be disturbed and malasanga will takes place, which may lead to jadya antrakunjana. A complete obstruction of mootra pureesha along with vata in the kostha in called anaha. Thesymptom may also be presented in the Amavata because of the accumulation of ama and malas inthe kostha, which causes vitiation of vata (Apanavata), which may obstruct the mala in the koshta.Clinical study of the effect of Amrita Manjari and Erandabrista Haritaki in the management of Amavata 59
  60. 60. Other symptoms such as abdominal discomfort or fullness and flatulence may be associated withconstipationClassification of Amavata: - On the basis of doshanubandha lakshanas and sadya asadyata. According to doshanubanda lakshanas it is of three varieties1) Vata 2) Pitta 3) Kapha (M.Ni 25)Vata: - If vata is predominant in the disease, it will cause more shoola in the joints and sometimesmay be in kukshiPitta: - If pitta is predominant, it causes daha all over the body and specifically at the joint involvedalong with raga or redness.Kapha: - If Kapha is predominant; sthaimithyam, gurutwam and kandu will appear prominently thanother symptoms. On the basis of sadyaasadyata the disease may be classified into seven varieties Eka doshanuga - 1) Vata 2) Pitta 3) Kapha Dwi doshanuga - 4) Vatapitta 5) PittaKapha 6) Kaphavata Sarva doshanuga - a) sannipata The symptoms of these varieties will be according to their predominance of doshas as statedearlier. Apart from the above classification, we can classify it into two varieties basing on severity ofthe disease. a) Pravridha Amavata (acute condition) in which the samanya lakshanas and pravridha lakshanas appears in severe form. b) Apravridha lakshanas – (sub acute or chronic condition)In which samanya lakshanas appears along with some pravridha lakshana in mild form. *******Clinical study of the effect of Amrita Manjari and Erandabrista Haritaki in the management of Amavata 60
  61. 61. SADYA – ASADYATASadya asadyata of Amavata can be studied basing on the following factors1. Dosha pradanyata2. Rogamargas3. Vayah4. Doshagathi5. Upakramanusar6. Kalanubandata7. Upadravas.1 1. Doshapradanyata: - According to dosha pradanyata, ekadoshanuga vyadhi is sadya,dwidoshanuga vyadhi is yapyam, sannipatika is krichra yapyam. 2. Rogamargas: - As we discussed earlier, Amavata belongs to abhyantara and madhyamaroga margas’hence the Amavata is said to be krichra saadya. 3. Vayahstah: - If Amavata occurs to a child; it is difficult to treat because balarogas arekrichra sadya. 4. Doshagati: - Amavata is krichra saadya because the doshagati is in marma, sandhi andhridaya. 5. Upakaramanusar: - It is krichrasaadya because the Amavata is having virudhopakrama.The internal causuative factors are Ama and Vata. Ama is snigdha, guru where as vata is rooksha,laghu hence it is krichra saadya in view of treatment. 6. Kalanubandha: - If patient suffers for a longtime more than a year it may become krichrasaadya or asaadya according to its teevrata. 7.Upadravas: - If upadravas such as sankocha, kanjatwadi follows the disease, it will betreated as asaadhya. If any organic involvement or damage present in the disease it can be said asasaadya. Usually the disease Amavata can be said as krichra saadya basing on its course, Rogamargam,Doshagati and in aspect of virudhopakrama. It is asaadya if any organic changes occur either in heartor in joints.Clinical study of the effect of Amrita Manjari and Erandabrista Haritaki in the management of Amavata 61
  62. 62. REFERENCES th 1. Charaka Samhita Soothra sthana Chapter 10 . *******Clinical study of the effect of Amrita Manjari and Erandabrista Haritaki in the management of Amavata 62
  63. 63. SAPEKSHA NIDANA The disease Amavata is easy to diagnose because it is having specific etiology, clinicalfeatures and it appears to be a specific disease entity. Even though, it may be obviously fair todiagnose when full clinical features appeared, but it may lead to confusion when all the signs andsymptoms have not appeared. Hence it is essential to differentiate with other diseases, whichmanifests specially in joints similar to Amavata and other general diseases, which may manifest inthe joints as a symptom of it. According to available literature, the disease which manifests in thejoints are vata rakta, sandhi vata, krostuka sheersha, hence the Amavata needs to be differentiatedwith these. Apart from the above joint diseases, there are some systemic diseases, which involve thejoints as their part of manifestation. They are 1. Vatolbana kapha pitta heena sannipatha jwara 2.Samasannipatha jwara. But these diseases may be differentiated with Amavata basing on otherclinical features of those diseases. The joint manifestations of the above diseases are localized whereas they are migratory in Amavata. Krostuka Amavata Vata Rakta Sandhi vata sheershaEtiological Amajanya Vata, rakta Vata prakopa ahara, Vata prakopa,factors ahara, guru, prakopa kara malnutrition. rakta prakopa,Ahara snigdha, ahara. matsya, vidhahi kara virudha ahara madya, ushna, ahara, pittala, teekshna guna ushna, ahara, guru ahara teekshna ahara.Clinical study of the effect of Amrita Manjari and Erandabrista Haritaki in the management of Amavata 63

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