Vaitaranabast amavata pk021_gdg

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EVALUATION OF THE EFFICACY OF VAITARANABASTI IN AMAVATA - AN OBSERVATIONAL STUDY By Dr. DEVENDRAPPA. F. BUDI Department of Panchkarma, D.G.M. Ayurvedic Medical College, Hospital and P.G. Research Center, Gadag.

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Vaitaranabast amavata pk021_gdg

  1. 1. EVALUATION OF THE EFFICACY OF VAITARANABASTI IN AMAVATA - AN OBSERVATIONAL STUDY By Dr. DEVENDRAPPA. F. BUDI.Dissertation Submitted to the Rajiv Gandhi University of Health Sciences, Karnataka, Bangalore. In partial fulfillment of the requirements for the degree of AYURVEDA VACHASPATHI M.D. In PANCHAKARMA Under the Guidance of Dr. P.Shivaramudu, M.D. (Ayu), M.A. (SAN), M.A (PSY) Professor, Post Graduate Department of Panchakarma. And co-Guidance of Dr. Santosh. N. Belavadi, M.D. (Ayu) Lecturer, Post Graduate Department of Panchakarma. DEPARTMENT OF PANCHAKARMA POST GRADUATE STUDIES AND RESEARCH CENTER SHRI.D.G.MELMALAGI AYURVEDIC MEDICAL COLLEGE GADAG -582103 2007
  2. 2. EVALUATION OF THE EFFICACY OF VAITARANABASTI IN AMAVATA - AN OBSERVATIONAL STUDY By Dr. DEVENDRAPPA. F. BUDI.Dissertation Submitted to the Rajiv Gandhi University of Health Sciences, Bangalore, Karnataka. In partial fulfillment of the requirements for the degree of AYURVEDA VACHASPATHI (M.D) In PANCHAKARMA Under the Guidance of Dr. P. Shivaramudu, M.D. (Ayu), M.A. (SAN), M.A (PSY) Professor, Post Graduate Department of Panchakarma. And co-Guidance of Dr. Santosh. N. Belavadi, M.D. (Ayu) Lecturer, Post Graduate Department of Panchakarma. DEPARTMENT OF PANCHAKARMA POST GRADUATE STUDIES AND RESEARCH CENTER SHRI.D.G.MELMALAGI AYURVEDIC MEDICAL COLLEGE GADAG -582103 2007
  3. 3. Rajiv Gandhi University of Health Sciences, Karnataka, Bangalore. DECLARATION BY THE CANDIDATE Hereby declare that this dissertation / thesis entitled “Evaluation of the Efficacyof Vaitaranabasti in Amavata – An observational study” is a bonafide and genuineresearch work carried out by me under the guidance of Dr. P. Shivaramudu, M.D.(Ayu), M.A. (SAN), M.A. (PSY), Professor, Post-graduate department of Panchakarmaand co-guidance of Dr. Santosh.N.Belavadi, M.D. (Ayu) Lecturer, Post graduatedepartment of Panchakarma.Date: Signature of the CandidatePlace: (Dr. Devendrappa. F. Budi)
  4. 4. SHRI D.G. MELMALAGI AYURVEDIC MEDICAL COLLEGE, GADAG. POST GRADUATE DEPARTMENT OF PANCHAKARMA CERTIFICATE BY THE GUIDE This is to certify that the dissertation entitled “Evaluation of the Efficacyof Vaitaranabasti in Amavata – An observational study” is a bonafide research workdone by Dr. Devendrappa. F. Budi in partial fulfillment of the requirement for thedegree of Ayurveda Vachaspathi. M.D. (Panchakarma).Date: Signature of the GuidePlace: Gadag. Dr. P. Shivaramudu M.D. (Ayu), M.A. (SAN), M.A (PSY) Professor, Post Graduate Department of Panchakarma. Shri D. G. Melmalagi Ayurvedic Medical College, Gadag – 582103.
  5. 5. SHRI D.G. MELMALAGI AYURVEDIC MEDICAL COLLEGE, GADAG. POST GRADUATE DEPARTMENT OF PANCHAKARMA CERTIFICATE BY THE CO-GUIDE This is to certify that the dissertation entitled is “Evaluation of theEfficacy of Vaitaranabasti in Amavata – An observational study” a bonafide researchwork done by Dr. Devendrappa. F. Budi in partial fulfillment of the requirement for thedegree of Ayurveda Vachaspathi. M.D. (Panchakarma).Date: Signature of the Co-GuidePlace: Gadag. Dr. Sontosh. N. Belavadi, M.D. (Ayu). Lecturer, Post graduate department of Panchakarma. Shri D. G. Melmalagi Ayurvedic Medical College, Gadag – 582103.
  6. 6. SHRI D.G. MELMALAGI AYURVEDIC MEDICAL COLLEGE, GADAG. POST GRADUATE DEPARTMENT OF PANCHAKARMA ENDORSEMENT BY THE H.O.D AND PRINCIPAL OF THE INSTITUTION This is to certify that the dissertation entitled “Evaluation of theEfficacy of Vaitaranabasti in Amavata – An observational study” is abonafide research work done by Devendrappa. F. Budi under the guidance ofDr.P.Shivaramudu, M.D. (Ayu), Professor, Postgraduate department of Panchakarmaand co-guidance of Dr. Sontosh. N. Belawadi, M.D. (Ayu), Lecturer Post graduatedepartment of Panchakarma.Dr.G.Purushottamacharylu, M.D. (Ayu) Dr. G. B. Patil.Professor & HOD Post graduate department PrincipalOf Panchakarma. Shri D. G. Melmalagi Ayurvedic Medical College, Gadag – 582103.
  7. 7. COPYRIGHT Declaration by the candidate I here by declare that the Rajiv Gandhi University of Health Sciences, Karnataka shall have the rights to preserve, use and disseminate this dissertation / thesis in print or electronic format for academic / research purpose. Date: Signature of the candidate Place: Dr. Devendrappa. F. Budi© Rajiv Gandhi University of Health Sciences, Karnataka.
  8. 8. Acknowledgement Any research is never an individual effort. It is contributory effort of many hearts,hands and heads. It gives me inexpressible pleasure to offer my sincere thanks to all thosewho have rendered their wholehearted support, guidance and Co-operation in completingmy thesis work. I express my deep sense of gratitude to their great holiness of ShreeGonibasaveswara and Shree Bidarallyamm for their divine blessings. My deep sense of gratification is due for my father Dr.Fakkirappa. M. Budi andmy Mother Smt. Neelamma, who are the architects of my career, culture and discipline,which I could imbibe, are solely because of their pains taking, upbringing and strongmoral support. I express my obligation to Shri.H.Beerappa and Smt.Pushpa, Mantesh,Harshavardhana, Yashoda, Shri.Dayanadappa and Smt.Prema, Guramma, Arunkumarand Gurunatha, Shri.Ningappa and smt Annalakshi, Savita, Shreekant and Shashikanta,Shri.H.Basavarajappa and smt Shoba, Komalakrisha, Nivedita and Ravichandra for theirvaluable support. I express my obligation to my honorable H.O.D, Dr. G. PurushothamacharyuluM.D. (Ayu), H.O.D., P.G. Department of Panchakarma, P.G.S&R, D.G.M.A.M.C, Gadagfor his critical suggestions and expert guidance for the completion of this work. I am extremely happy to express my deepest sense of gratitude to my belovedGuide Dr.P.Shivaramudu.MD(Ayu),M.A.(SAN),MA(PSY), Professor, P.G. Departmentof Panchakrma, P.G.S & RC, D.G.M.A.M.C, Gadag whose sympathetic, scholarlysuggestions and guidance at every step have inspired me not only to accomplish this workbut in all aspects. I express gratitude to my Co-Guide Santhosh. N. Belavadi MD (Ayu), Lecturer,P.G. Department of Panchakarma, P.G.S & RC, D.G.M.A.M.C, Gadag for his constantsupervision, guidance encouragement and wholehearted support during my researchstudy. I express my deep gratitude to Dr .G.B Patil, Principal, D.G.M.A.M.C, Gadag, forhis encouragement as well as providing all necessary facilities for this research work.
  9. 9. I express my sincere gratitude to Dr. Sureshbabo. MD (Ayu) Professor, P.G.Department of Panchakarma, P.G.S & RC, D.G.M.A.M.C, Gadag. Dr. Sahidhar.H.Doddamani. MD (Ayu) Lecturer, for their sincere advices and assistance. Dr.C.V.Rajshekar.MD (Ayu) Lecturer P.G. Department of Panchakarma, for their sincere advices andassistance. Dr.P. Yasmin, MD (Ayu) Lecturer P.G. Department of Panchakarma, for theirsincere advices and assistance. I take this opportunity to thank HOD’s of other departmentsDr.M.C.Patil MD (Ayu), Dr.Varadhacharyulu MD (Ayu), and Dr.G.V.Mulgund MD (Ayu) for theirinspiration and valuable suggestions. I am grateful to all the PG teachers Dr.K.S.R.PrasadMD.(AYU), Dr.R.Y.ShetterMD(AYU), Dr.A.Samudri.MD(Ayu), Dr.Girish.Danappagouder,MD(Ayu), Dr.Jagadeesh.G.Mitti.MD.(AYU), Dr.Kuber.SankMD.(AYU), Dr.Dilipkumar.B,MD(Ayu), Dr.ShashidharNidagundiMD.(AYU)), and other PG Staff. For their valuable suggestions. I extend my immense gratitude to Dr.G.S.Hiremath, Dr.S.A.Patil, Dr.U.V.Purad,Dr.B.G.Swami, Dr.Paraddi, Dr.Sajjana, and Dr.Shankaragouda, Dr.G. Yarageri,Dr.S.H.Radder, Dr.Mulkipatil and Tippanagouder (Lab technician) and other teachingstaff who helped during my study. I am greatly thankful to my friend Dr.Vanishree and friends, Deepamol.K.andMr.Santosh. B. Hugar, BE (Civil) for their valuable support. I would like to express my sincere thanks to Librarian Shri.V.M.Mundinamani,and Asst Librarian Shri.S.B.Sureban and Shri Shavi for providing valuable books in timethroughout the study. I take this moment to express my thanks to all my Departmental Friends Dr.Subin, Dr. Febin, Dr. Satheesh, Dr. Santosh, Dr.Varsha Dr. Shaila, Dr.MahanteshHugar, Dr. Chandramouli, Dr. Jayaraj, Dr. Kendadmath, Dr. Hakkandi, Dr. Ashwin,Dr.lingaraddy, Dr.Vijay, Dr.Manjunath Akki, Dr. Sibu , Dr.Payappagouder, Dr.prasanna,Dr. Madhushree, Dr.Nataraj, Dr. Udayaganesh, Dr adarsh, Dr,Mukta, Dr.Shailej.Dr.Deepak. Dr.Jayashankar, Dr, Rajesh, Dr.Sabareesh, Dr.Sanath. I take this moment to express my thanks to all my Post Graduate friendsDr.Channaverswami, Dr.Krishna, Dr.Gavi, and Dr.Sarvi. Dr.Kalmath, Dr.Ashok,Dr.Kendadmath, Dr.Sajjanar, Dr. Basavaraj Ganti, Dr.Pradeep, Dr.Venkareddy, ,
  10. 10. Dr.Sunita, Dr.Bingi, Dr.Ratan, Dr.Uday, Dr.Hugar, , Dr.Ashwini, , Dr.Shalini, Dr.Shivaleela,Dr.Kataraki, Dr,Kattimani, Dr. Sulochana, Dr.Jayashree Dr.Anita, and otherpost graduate scholar for their support. I am very much thankful to Smt. P. K. Belavadi, Mr. M. M. Joshi, Mr. Shankar,Mr. Biradar, Mr. Dasar and Smt. Sarangamath and Mr. Kulakarani. Last but not least, I thank to the patients who are pillars of my research work.Iexpress my thanks to all the persons who have helped me directly & indirectly withapologies for my ability to identify them individually. Dr. Devendrappa. F. Budi.
  11. 11. Abstract: In Ayurveda chikitsa is broadly classified into two parts shodhana and shamana. Herealso shodhana occupies first place. Among five shodhana procedures Vasti is one amongthem and it has been called as Ardhachikhtsa. Amavatat is commonest among chronic inflammatory joint diseases in which jointsbecome swollen, painful, and stiff. It is a debilitating disease in view of its chronicity andcomplications. Therefore, it has taken the foremost place among the joint disorders. The crippling nature, repetitive attacks and chronic course of Amavata, forced thescientific world to conduct extensive studies on Amavata. Unfortunately the man has notsucceeded in eradicating this diseases and find to come out with successful therapeuticmeasures that can cure the patient completely. So the disease drawing attention for the consideration of research firstly due togravity of the problem secondary due to lack of suitable medicines and society of presentera are looking for the successful management of Amavata. So the present study isentitled “EVALUATION OF THE EFFICACY OF VAITARANA BASTI INAMAVATA” – An observational study is undertaken. The objectives of the study are 1). To Evaluate of the effect of Bastikarma inAmavata. Anad 2).To Evaluate of the efficacy of Vaitaranabasti in Amavata. The aim of this study was to find out the effect of Vaitaranabasti in the managementof Amavata. The study is a prospective observational clinical trail in a single group of 30patients, where all the patients received Vaitaranabasti for 8 days and a parihara kala(follow up) of 16 days is given. Subjective parameters i.e. Bahusandhishoola, Bahusandhishota, Stabdhata andSpershasahishnuta are the chief complaints of Amavata and objective parameters areHb%, ESR, CRP, RA, NRS(Assessment of pain),VAS(Assessment of pain), RAI,EAMRAI, GDA, AIMS, Physical Disability, Walking Time, Grip Strength, Range ofMovements, DAS criteria, Ayurvedic health assessment, Assessments are done beforeand after the treatment.Among 30 patients, 13 (43.33%) patients were shown good response i.e. above 75% insigns and symptoms, 17 (56.66%) patients responded moderately i.e. 50-75% in signs andsymptoms. all the subjective and objective parameters showed highly significant.
  12. 12. Amavata is a Kapkavata vyadhi affecting people in the Madhyama avasta. Thedisease is obtained by the involvement of Ama and Vata, characterized by Ruja andShotha in Sandhi sthanas. Therefore, the agents/therapies of Amapachana, Lekhana,Vatanulomana etc, and properties should be used in this disease. So Patyadichurana isused for Deepanapachana, Sadyovirechana (Eranda taila) imparts Agnideepana,Vatanulomana and opens up the srotas in the shareera facilitating more nourishment andfree movement of Vata dosha followed by Vaitaranabasti. Vaitaranabasti. is primetreatment for Amavata in turn plays vital role in correcting pathology of the disease andgives remarkable results. This results in the relief of symptomatology of the disease, by acting locally andsystematically. The ingredients of the Vaitaranabasti are having the quality of deepana,pachana gunas, which dairectly influences the koshtagni and dhatwagni, which inturnleads to pachana of already existing ama and obstructs the further production of ama.And it is also having vatanulomana and vata shlesmahara properties. There by, it is anideal treatment of choice in Amavata.Key words: - Patyadi choorna, Eranda tail-Sadyovirechana, Amavata, RheumatoidArthritis, Vaitaranabasti.
  13. 13. TABLE OF CONTENTS Chapters Page No1. Introduction 01 - 042. Objectives 07 - 073. Review of Literature 08 - 634. Methodology 64 - 765. Observations and Results 77 - 1056. Discussion 106 - 1287. Conclusion 129 - 1308. Summary 131 - 1329. Bibliography 133 - 14710. Annexure
  14. 14. List of TablesTable No Page No1. Showing Amavata Nidana according to various Acharyas 292. Showing the similarity between Amavata and Rheumatoid Arthritis 343 Showing lakshans According to different Ayurvedic classics 364 Showing the Sthananusara Laxana 375 Showing various Upakramas have been prescribed by different 44 Acharyas for the treatment of Amavata:6. Showing extra articular features of RA 537. Showing differential diagnosis regarding with Amavata 558 Showing the Composition and Properties of Patyadi Churna 639. Showing the Quantitative assessment of pain 7010. Showing the Ayurvedic Health Assessment (AHA): 7211. Showing the Arthritis Impact Measurement Scale (AIMS) 7312. Showing Physical Disability 7413. Showing distribution of patients by age groups 7714. Showing distribution of patients by Sex 7815. Showing distribution of patients by Socioeconomic Status 7916. Showing distribution of patients by Dietary habits 8017. Showing distribution of patients by Treatment history 8118. Showing distribution of patients by Koshta 8219. Showing distribution of patients by Jataragni 8320. Showing distribution of patients by Vyasana 8421. Showing distribution of patients by Dehaprakruti 8522. Showing distribution of patients by Occupational Status 8623. Showing distribution of patients by Religion 8724. Showing distribution of patients by RA factor 8825. Showing distribution of patients by CRP Titer 8926. Showing distribution of patients by Bahusandhishoola Response to the treatment 90
  15. 15. 27. Showing distribution of patients by Bahusandhishota Response to the treatment 9128. Showing distribution of patients by Bahusandhigraha Response to the treatment 9229. Showing distribution of patients by Sparshasahishnuta Response to the treatment 9330. Showing distribution of patients by walking time Response to the treatment 9431. Showing distribution of patients by Grip Strength Response to the treatment 9532. Showing distribution of patients by Range of movements’ Response to the treatment 9633. Showing distribution of patients by DAS criteria Response to the treatment 9734. Showing the overall effect of treatment 9835. Showing the Data related to the response of Treatment to Subjective parameters 9936. Showing the Data related to the response of Treatment to objective parameters 10037. Showing the Data related to the response of Treatment to objective parameters 10138. Showing the Data related to the response of Treatment to objective parameters 10239. Showing the Data related to the response of Treatment to objective parameters 10340. Showing the statistical analysis of Subjective and Objective parameters 10441. Showing the mean % improvement of Subjective and Objective parameters 105
  16. 16. List of Graphs1. Showing distribution of patients by age groups 772. Showing distribution of patients by Sex 783. Showing distribution of patients by Socioeconomic Status 794. Showing distribution of patients by Dietary habits 805. Showing distribution of patients by Treatment history 816. Showing distribution of patients by Koshta 827. Showing distribution of patients by Jataragni 838. Showing distribution of patients by Vyasana 849. Showing distribution of patients by Dehaprakruti 8510. Showing distribution of patients by Occupational Status 8611. Showing distribution of patients by Religion 8712. Showing distribution of patients by RA factor 8813. Showing distribution of patients by CRP Titer14. Showing distribution of patients by Bahusandhishoola Response to the treatment 8915. Showing distribution of patients by Bahusandhishota Response to the treatment 9016. Showing distribution of patients by Bahusandhigraha Response to the treatment 9117. Showing distribution of patients by Sparshasahishnuta Response to the treatment 9218. Showing distribution of patients by walking time Response to the treatment 9319. Showing distribution of patients by Grip Strength Response to the treatment 9420. Showing distribution of patients by Range of movements’ Response to the treatment 9521. Showing distribution of patients by DAS criteria Response to the treatment 9622. Showing the overall effect of treatment
  17. 17. List of flow chart1. Flow chart showing Samprapti of Amavata 312. Flow chart showing pathogenesis of RA 51
  18. 18. IntroductionIntroduction Ayurveda assigns of locomotor and associated motor functions to the fivekarmendriaas ex: Vak, Pani, Payu, Pada and Upasta. Vata is the driving force to performnormal activities of karmendrias. Pitta performs its functions through substantive andmetabolic power which is the cause of bio chemical energies, and kapha through thenourishing and preserving powers which protect the human organism. Dharma, Artha, Kaama are three important factors to be fulfilled by a person duringhis life aiming, to attain ultimate goal of everybody i.e. ‘MOKSHA’ (Salvation). Humanbeing knowingly or unknowingly struggles to finish them at their ability. But Arogya(health) is essential to achieve them. This wealth one has to protect at any cost.‘Sheeryate Anena Iti Shareeram’ indicates that, the body gets affected (destructed) duringvarious activities of routine life. Hence there is always fear of getting imbalance bothstructurally and functionally. But as the daily balanced diet with proper following up ofDinacharya, Ruthucharya etc. one can get corrected without his knowledge. Thisphenomenon has certain limitation. Living in the external atmosphere the changes in theform of Heena, mithya and Atiyoga with respect to Kala-Artha-Karma forces him todetritions in the fundamental units of the body called as Doshas-Dathus and Malas. Asthey get self corrected, person meantime commits mistakes known as Prajnaparadharesults in the form of disease manifestation. In the present competent and tense world, people are so much busy that theycannot follow Swasthavrittha and Sadurittha. So cannot rectify the imbalance in theirbody or totally ignores till he becomes unable to perform his routine work properly. Theyare not taking sufficient rest in time. Even they cannot have their food in appropriate andfixed time. Food may not be having rich properly of Rasa, Guna etc. Use of packed foodand freezed items are also seen widely. Changing world made the people may not givechance to practice proper exercises like walking etc. More number of vehicles, factories,oil refineries, overcrowds etc. makes pollution of air, water etc. In simpler words man inthe name of modernization looses his natural power of immunity and depends on severalartificial methods for everything. Thus becomes focus of diseases easily.Evaluation of Efficacy of Vaitaranabasti in Amavata-An observational Study 1
  19. 19. Introduction Amavata is such a disorder where etiology points out commitment of Viruddha aharaand Viruddha chesta. It is a troublesome disorder, manifests for a long time, leads tocomplications and unless treated early and perfectly it makes oneself to confine to bed. It Affects many facets of patients life, for example his family, occupational andcommunity relationships. It affect not only the social and economical position ofindividual and his family but it leads to the draining of national resource due to the workhours lost, resulting in diminished production. It is a multifactorial disease, if not treated in early stage, a structural deformity isdeveloped and the life of the patient is ruined. The disease is progressive in nature withprognosis of the disease is bad and leads to joint deformities. Rheumatoid Arthritis occursthroughout the world and in all ethnic groups. The prevalence is highest in Indians. InCaucasians it is around 1-1.5% with a female: male ratio 3:1.1The onset of RheumatoidArthritis may occur at any time of the life approximately 70% of RA occurs between thethird to fifth decades.2 The crippling nature, repetitive attacks and chronic course of Amavata, forced thescientific world to conduct extensive studies on Amavata. Unfortunately the man has notsucceeded in eradicating this diseases and find to come out with successful therapeuticmeasures that can cure the patient completely. In Ayurveda also many scientific studieswere carried out in different centers. In recent years an intense study of different conditions primarily involving themusculoskeletal structures (Rheumatology) has been made and it revealed thatinflammatory or digestive changes occur in diseases like Rheumatoid Arthritis. Diseasesof connective tissue are responsible for much temporary or permanent disablement. Despite the awareness of the diseases, responsible explanation for the cause andsource of Rheumatoid Arthritis are still obscure in modern science. Hence no rationalcurative measures are known. Anti-inflammatory Analgesics and diseases modifying Anti Rheumatic drugs are thedrugs of choice in contemporary system of medicine. Unfortunately all the analgesics areliable to give many side effects particularly by repeated and prolonged use.Evaluation of Efficacy of Vaitaranabasti in Amavata-An observational Study 2
  20. 20. Introduction Ayurveda, the age old Indian System of Medicine, advocates a reliable managementof diseases with the consideration to protect the normal health while treating the diseaseswith highly efficacious and easily and easily available drugs based on humeral theory. Ayurvedic approach to diseases Amavata is to re establish the body structure and tobalance the vitiated doshas. Alleviation of Vata dosha has special importance in themanagement. Langhana, Swedana, Deepana, Rechana, Snehapana and Basti are thetherapeutic measures are advocated. Till now more than 100 research works have been carried out at various AyurvedicInstitutions and about 25 Research works have been carried out in P.G. Institutes. Thislarge number itself suggests its large occurrence and faith of patients in AyurvedicManagement. • In 2003, Deepak S.M. worked on “ A comparative study of Eranda paka and Ajamodadichurna in the management of Amavata” • In 2003, Riti shah Worked on “ Clinical assesement of the role of Kamsa hareetaki and Virechana in the management of Amavata” • In 2004, Veerakumar studied on “Comparative study of Shamana and shodana chikitsa in Amavata. • In 2004, Gururaj worked on “A stydy on Indravalli W.S.R.T.its effect on Amavata” • In 2005, P. Koteshra stydied on Preparation, Physico chemical Analysis of Hinguleshwara rasa and its clinical Efficacy on Amavata W.S.R.T. Rheumatoid Arthritis” • In 2005, Veena kori studied on “Evaluation of efficacy of Shunti and Gokshura in Amavata (Rheumatoid Arthritis) –A comparative clinical study. • In 2006, Prathima adiga worked on “A study on effect of Bandhadi yoga in the management of Amavata (Rheumatoid Arthritis). • In 2006, Praddep Agnihotri worked on “Preparation and Analytical study of Shri siddha daradamruta Rasa and its clinical effect in Amavata” • In 2007, Suresh hakkandi worked on “A Comparative Study of Virechana karma and Basti karma in Amavata W.S.R.T. Rheumatoid Arthritis. • Etc…Evaluation of Efficacy of Vaitaranabasti in Amavata-An observational Study 3
  21. 21. Introduction So the disease drawing attention for the consideration of research firstly due to gravity of the problem secondary due to lack of suitable medicines and society of present era are looking for the successful management of Amavata. So the present study is entitled “EVALUATION OF THE EFFICACY OF VAITARANA BASTI IN AMAVATA” – An observational study is undertaken. .Evaluation of Efficacy of Vaitaranabasti in Amavata-An observational Study 4
  22. 22. Objectives Objectives: • In today’s era the people want to leave a luxurious, due to sedentary life style with improper dieting habits occurrence of Amavata on large scale is one of the outcomes of this modification. • It is commonest among chronic inflammatory joint diseases in which joints become swollen, painful, and stiff. It is a debilitating disease in view of its chronicity and complications. Therefore, it has taken the foremost place among the joint disorders. • It continues to pose challenge to physician due to severe morbidity and crippling nature and claiming the maximum loss of human power making it a biggest world wide burning problem irrespective of races. • It is equated with Rheumatoid Arthritis, an inflammatory Auto-immune disorder. The lives of more than one million people are physically impaired due to Rheumatic disorders and one fifth of these are severely disabled. • Anti-inflammatory Analgesics and diseases modifying Anti Rheumatic drugs are the drugs of choice in contemporary system of medicine. Unfortunately all the analgesics are liable to give many side effects particularly by repeated and prolonged use. • By seeing the above said hazards because of the disease and the complications arising from the drugs used in contramprary medicine, it seems to be good to look at the Ayurvedic remedies. • Many theories and practical approaches have been tried to get a better answer for solving this problem. But being a Yapya Vyadhi it reappears and gives long standing sufferings. However, improper follow up, faulty dieting, irregular exercises, poor economic status excessive work load, improper life style and mental stress play vital role in the failure. Anyhow, keeping all these in mind, an effort has been done to find out and analyze in this study in the guidelines explained in Ayurvedic classics. • The Panchakarma therapy is an integral part of Ayurveda many diseases according to Ayurveda are direct result of Srotavarodha particularly due to the Agnimandya and Ama.3 The management of Amavata, Ayurveda givesEvaluation of Efficacy of Vaitaranabasti in Amavata-An observational Study 5
  23. 23. Objectives importance to shodhana karma. Among shodhana Virechana and Basti karma have got its vital role in treatment and preventing the disease.4 Shodhana karma helps to eradicate the cause of the disease and as such the disorders treated with shodhana do not reoccur.5 • So considering this aspect in the present study an attempt is made to find suitable remedy for Amavata as mentioned specially by Chakradatta,6 i.e. Vaitaranabasti is taken and hypothetically the following objectives are evalued 1. Evaluation of the effect of Bastikarma in Amavata. 2. Evaluation of the efficacy of Vaitaranabasti in Amavata.1. Evaluation of the effect of Bastikarma in Amavata: • ‘Vata’ is responsible for smooth functioning of the different systems in the body. Pitta-Kapha Doshas, as well as the Dhatus and Malas are handicapped Without the support of Vata and cannot work independently. Just like wind carries the clouds (in the sky), the Vata helps other Doshas and Dushyas during various activities of routine life. • In Amavata ‘Ama’ is produced by agnimandya of both Jatharagni and Dhatwagnis. It is the main causative factor. Ama and vata vitiated simultaneously and disease is manifested mainly in joints of hasta, pada, sira, trika, gulpha, janu and uru. The main symptoms produced are Angamarda Aruchi, Trishna, Alasya, Gouravam, jwara, Apaka and Shotha. • So this derangement of the vata may be corrected by this vasti, as vasti is the prime and important treatment modality for vata. So it may helps to avoid the complications. Basti is said to be ideal as it pacifies both ama and vata. • The symptoms of avarana vata are seen in the joints, the main seat of vata is pakwashaya, and hence the eliminative therapy is directed to pakwashaya. After the administration of basti, the basti is retained only for limited period in the pakwashaya even then it can be assumed from the effects produced that, and the essentials are absorbed in the systemEvaluation of Efficacy of Vaitaranabasti in Amavata-An observational Study 6
  24. 24. Objectives2. Evaluation of the efficacy of Vaitaranabasti in Amavata: • The shodana therapy is must to treat the disease Amavata, among the shodana bsti is said to be ideal as it pacifies both ama and vata. • Chakrapani has appreciated the role of ksharabasti has got its importance in the treatment of Amavata. • The explanation of Vaitaranabasti follows the ksharabasti with most of the same ingredients but with reduced quantity, which can be tolerated when compare to the ksharabasti. • Vaitaranabasti is indicated in Amavata as well as in Shula. • The ingredients of Vaitaranabasti are cheap and easily available • The symptoms of avarana vata are seen in the joints, the main seat of vata is pakwashaya, and hence the eliminative therapy is directed to pakwashaya. After the administration of basti, the basti is retained only for limited period in the pakwashaya even then it can be assumed from the effects produced that, and the essentials are absorbed in the system • The ingredients of the Vaitaranabasti are having the quality of deepana, pachana gunas, which dairectly influences the koshtagni and dhatwagni, which inturn leads to pachana of already existing ama and checks the further production of ama. And it is also having vatanulomana and vata shlesmahara properties. • After administration of basti it reaches the various parts of the body like sandhisand even to the minute channels by its suksma guna and liquefies the ama and kapha which was present in various forms. Liquification is caused by ushna, teekshana and lekhana gunas which inturn decreases the srothoabhishyandhana meanwhile usna and snigdhata guna of the content pacifies the vata. Gomutra, which is the chief content, is helpful to reduce the shotha and ruja as it is mainly indicated in ama.Evaluation of Efficacy of Vaitaranabasti in Amavata-An observational Study 7
  25. 25. Historical ReviewReview of literature:Historical review of vasti1) Veda kala: Direct reference of Vasti karma will not be found in Veda, but explanation ofVasti is their as “Vishitam te Vastibilam” 72) Purana kala Vasti is indicated as the principal remedy in the problem of increase ofVatadosha in Agnipurana.8 Different Snehas has told to use for Vasti according toseason93) Samhita kala Most of the Ayurvedic classical text have given much importance to Vasti karma,that’s why we found separate Adhyayas for explaining Vasti karma and while dealing thetreatment of each disease we will find the elaborate version of Vasti Dravya andpreparation. Vasti review of Samhita can be studied by referring Charaka samhita, Susrutasamhita, Astanga sangraha and Astanga hridaya.Charaka samhita Charaka has explained definition of Vasti, Types of Vasti, preparation of Vasti,Procedure of Vasti, Karmukata of Vasti, Vasti Vyapat its Chikitsa, Vasti dravyas etc.10Sushruta samhita Sushruta widely explained definition of Vasti, Types of Vasti, preparation ofVasti, Procedure of Vasti, Karmukata of Vasti, Vasti Vyapat its Chikitsa, Vasti dravyasetc in his Chikitsa sthana.11Vagbhata 12 13 Both in Astanga sangraha and Hridaya elobarate description of Vasti havebeen told in Sutrasthana and regarding Vasti Dravya we will find in Kalpasthana.14, 15Evaluation of Efficacy of Vaitaranabasti in Amavata-An observational Study 8
  26. 26. Historical ReviewKashyapa Samhita: In Kashyapa Samhita, Basti has been explained in detail in Siddhisthana andKalpasthana.16Bhela Samhita: In Bhela Samhita, description of Basti is available in four chapters ofSiddhisthana namely Bastimatriya Siddhi, Upakalpa Siddhi, Phalamatra Siddhi andDosha Vyapadika Basti Siddhi.17Harita Samhita: In this text, only 3rd chapter of Sutrasthana deals with Basti.18Chakradatta: In this text, two chapters named Anuvasanadhikara and Niruhadhikara are dealtwith Anuvasana and Niruha Basti respectively. 19Vangasena: In Chikitsa Sarasangraha, Vangasena has devoted “Basti Karmadhikara” chapterfor description of Basti.Sharangadhara Samhita: Three chapters of Uttarakhanda namely Basti Kalpana Vidhi, Niruha BastiKalpana Vidhi and Uttara Basti Kalpana Vidhi described various aspects of AnuvasanaBasti, Niruha Basti and Uttara Basti respectively.20, 21, 22Bhavaprakasha: In this 5th chapter of Purvakhanda has been contributed to the description ofBasti. Vrana Basti – this type of Basti has been explained in this Grantha.23Kalyanakaraka: In this text, Basti is described in Vatarogadhikara only.Todarananda: In this text, Basti is described in the chapter Basti Vidhi.Historical review of Amavata An off shoot of Atharva and Rigveda, this science of medicine is withoutbeginning, but Ayurveda saw throughout many people, who organized it into beautifullyEvaluation of Efficacy of Vaitaranabasti in Amavata-An observational Study 9
  27. 27. Historical Reviewwoven treatises, incorporating newer diseases and their treatment, which cropped upduring their times. It is evident in the Samhitas that the most prevalent and deadlydiseases have been devoted separate chapters were included as secondary diseases underthe major category.Vedic period (5000 BC to 1000 BC): Clear cut explanations of Amavata are not available in Vedic Samhitas, butdisease caused by Kapha have been more or less described under the major headingBalasa, but the diseases of joints are not included here. Sayana has quoted few referencesindicating arthritic syndromes, such as-Rapasi: 24 Disease arising due to sin (Rigveda) characterized by pain in multiple jointsalso referred to as Papa. Yakshma and treatment with Jala, Vayu Yava, and Kushta havebeen indicated.Jayanya25: This disease is said to affect the bones cervical vertebrae and arise fromwomen through Sanga. Whether the disease refers to rheumatoid arthritis is still not clear.Grahi26: (Rigveda and Atharvaveda): This has been described as the disease of joints butcharacteristic features have not been clearly mentioned. Treatment of this disease withDashavruksha has been mentioned.Vatikrut27: This disease has been described as a serious ailment caused by Vata andtreatment with Pippali and Vishanashaka has been mentioned.Sandhivikruti28: (Atharvaveda): This disorder is caused by Sleshma and can be treatedwith prayers.Samhita period (1000 BC TO 600 AD): Charaka Samhita: Charaka has described in detail Ama and Ama PradoshajaVikara and their treatment with Langhana and Ullekhana.29 Charaka had described treatment for Amavata while dealing with Avarana 30Chikitsa in Vatavyadhi, which indicate Pramehahara and Medohara Vidhi. Amavatafinds a mention in the list of therapeutic indication of Kamsa Hareetaki 31 in ShwayathuChikitsa and Vishaladi Phanda in Pandu Chikitsa. 32Evaluation of Efficacy of Vaitaranabasti in Amavata-An observational Study 10
  28. 28. Historical Review 33 The treatment of Ama in Grahani Chikitsa by Charaka is similar to thedescription of Amavata Chikitsa by Bhava Mishra i.e. Langhana, Pachana and oraladministration of Panchakola Phanta34 same is the case with Amavata Chikitsa ofChakrapani in Chakradatta 35Sushruta Samhita: The description of Amavata in Sushruta Samhita is conspicuous byits absence.Bhela Samhita: The tenth chapter in Sutra Sthana deals with Ama Pradosha. Thisdescription has some resemblance with that of Amavata.Harita Samhita: A complete chapter on Amavata finds a mention in Harita Samhita.36The classification of Amavata is quite unique and not followed by any of the later worksin this field.Anjana Nidana: This work is claimed to be written by Acharya Agnivesha, containsdetailed description about etiology, premonitory symptoms, clinical manifestations andcomplications.Sangraha Kala (600AD-1600AD): Astanga Sangraha and Astanga Hridaya have ignored the disease though the word 37Amavata is included in the therapeutic index of compounds Vatsakadi Yoga andVyoshadi yoga.38 39Madhava Nidana: Madhavakara stated this disease as a separate entity and has dealtseparate chapter.Chakradutta: Chakrapanidutta is the first to described the treatment for Amavata. 40 Vangasena 41 followed Madhava with little additions yoga in the treatment aspect. 42 43Works like Bhava Prakasha, Yogaratnakara and Bhaishajya Ratnavali 44 have onlycorroborated the descriptions with additional principles of treatment.Adhunika Kala (1600AD onwards): Mahopadhyaya Acharya Gananathsen has coined the term Rasavata for Amavata. In yoga shastra the practice of shushka basti for improving the jataragni andtreating Amavata has been mentioned.45Y.N.Upadhyaya (1955) has correlated the disease with rheumatoid arthritis. Laterresearch workers have agreed with Y.N.Upadhyaya.Evaluation of Efficacy of Vaitaranabasti in Amavata-An observational Study 11
  29. 29. Historical ReviewReview of Rheumatoid Arthritis 46 First Century AD: The Rheumatoid/rheumatology is derived from the root‘Rheuma’, which refers to a substance that flows and probably was derived from phlegm,an ancient primary humor, which was believed to originate from brain and flow tovarious parts of the body causing ailments.1642 A.D.: The word rheumatism is introduced into the literature by the Frenchphysician Dr.G.Baillou who emphasized that arthritis could be a systemic disorder.1800 A.D.: Landre Baervier a physician from Salta Petruver in Paris seemed to havedescribed the disease for the first time he called it Gartte Asthanique Primitive.1857 A.D.: Sir Garrod proposed the name Rheumatoid Arthritis, Bannatyne also in 1959published his pathological observations on the disease but he could differentiate it fromOsteoarthritis only in his later edition.1928 A.D.: The American committee for the control of rheumatism is established in U.S.by Dr.R.Pemberton, renamed American Association for the study and control ofrheumatic disease (1934), then American Rheumatism Association (1937) and finallyAmerican college of Rheumatology (ACR) (1988).1940 A.D.: The terms Rheumatology and Rheumatologist are first coined by Drs.Hollander and Comroe respectively.1948 A.D.: Roses identified some criteria for diagnosis of Rheumatoid Arthritis.1958 A.D.: American Rheumatic Association suggested uniform criteria for diagnosis.1987 A.D.: The criteria were revised. In the beginning it was thought to be an infective condition especially in early 20thcentury. French scientists thought it to be due to tuberculosis.Hench and Kendell introduced steroids in the management of rheumatoid arthritisdescribed pediatric onset, juvenile Rheumatoid Arthritis. in 1896. Later Felty A.R.described Felty’s syndrome. Recent advancement in immunology has opened new vistas in the management ofRheumatoid Arthritis. Unfortunately till date the etiology of Rheumatoid Arthritis isunknown the pathogenesis is speculative, the treatment is only palliative and there is nocure to this disease.Evaluation of Efficacy of Vaitaranabasti in Amavata-An observational Study 12
  30. 30. Historical ReviewEvaluation of Efficacy of Vaitaranabasti in Amavata-An observational Study 13
  31. 31. Basti karmaBasti karmaVyutpatti “Vasti” the word derived from the root “Vas” with the suffix of Prattyaya“Tich”.Nirukti and Paribhasha 1. Using Ajadi Vasti Putaka for the use of giveing Aoushadha is called Vasti47 2. Due to giving medicine by Vasti Putaka is called Vasti.48, 49, 50 3. Due to administering medicine in to Gudamarga with Vasti is called Vasti.51 4. Which is Sadhyakarma with Mootradhara Putaka is Vasti.52 5. The karma while moveing in Nabhi, Kati, Parshwa, Shroni churns up the stool including all the other doshas located their, and appropriately eliminates them with easy after doing Snehana of body is called Vasti 53Vasti Karmukhata Vasti is one of the best Chikitsa in Panchakarma, its action will not berestricted to only Pakwashaya Shodhana where as it acts all over the body. Bymixing different drugs it acts as Shodhana, Shamana, Lekhana, Brouhana,Vajikarana, Vayasthapana etc.54 So Vasti can be used in any type. Now its modeof action will be explained as follows. Just as the cloth absorbs only colour from the solution of Kusumbha andother coloring substances, so also the Vasti expels out from the body only thedoshas, which have been maid moist.55, 56 The body is sustained by Vayu because of its ability to cause detachmentof any adhesion. Vayu alone or along with other doshas get aggravated in its ownhabitat. Vasti by its Shodhana action causes downward movement of that Vayualong with Pitta, Kapha and feces. Because of allivetion of this Vayu, all thediseases pervading the whole body get alleviated.57 Chakrapani comments over above point and says, science Vasti causesalleviation of basic Vayu located in Pakwashaya other connected Vayus elsewhere in the body gets automatically alleviated. This holds good similardestruction of a tree by cutting its root. This explains the cure of all the diseasesof the body by simply correcting the Vayu located in its basic habitat ie colon.Evaluation of Efficacy of Vaitaranabasti in Amavata-An observational Study 13
  32. 32. Basti karma In Charaka siddhi Vasti is described to draw out all doshas from the footto the head by its Virya. Medicine injected through rectum remains in the intestines in the region ofthe pelvis and below the umbilical region. The potency Vasti dravya spreasds allover the organism from the Pakwashaya just as the potency of the water poured atthe root of the tree tends to permeate the whole tree through its minutest cells andfibers. The liquid part of Vasti is emitted out through the rectum either by it selfor with feocal matter etc. But its potency acts over whole organism through theintervention of Apana and other Vayus. The potency of the Vasti dravya in thePakwashaya acts on the while organisam from top to toe, like the sun in the havenacting on the humidity of the earth below. Vasti if applied correctly tends toeliminate completely from the system all the doshas accumulated in the region ofthe back, waist and abdomen. 58, 59, 60Importance of Basti karma 61 62 Vata is the Neta of all Dosas, it is considered as Ishvara and it is thecausative factor for all trimargaja rogas.63, 64 For this type of Vata Vasti is the bestamoung other Karmas.This Vasti is considered as Ardha chikitsa because ofdisease produced by Vata are 80 in number.65 Vasti can be utilized in Bala, Vridha, Krasha, Sthoola, Kshina dhatuperson, and in Sthree.66 In the Snehadi karma Basti is chief, because of havingShodhana effect, Shamana effect, Sangrahana effect, Vajikarana effect, Brohanaeffect etc. 67 Vasti is beneficial if it is used with different drugs in Vata, Pitta, Kapha,Samsargaja and Sannipataja disorders.68, 69 Vasti is Amruta samana in Shishu and Ashishu, 70 when Vasti is used incombination of Niruha and Anuvasana it eradicates all type of diseases.71 Main specialty of Vasti is first it do the Utkleshana of doshas thanShodhana of doshas and lastly Shamana of doshas.72, 73, 74 It is the only one Karma which we found to be given continuously for 324days, if Vasti is taken for such days person neither become old nor sick, lives forthousand years with keen sense organs, devoid of sins shining like gods, like astallion in matters of sex, like a elephant in strength with steady mind, senseorgans and digestive activity.75 Vasti if appropriately administered keeping in view the strength of patientdoshas involved in the causation of disease, nature of disease of disease, physicalEvaluation of Efficacy of Vaitaranabasti in Amavata-An observational Study 14
  33. 33. Basti karmaconstitution of patient and properties of different groups of drugs prescribed fordifferent diseases cures these ailments.76 No other therapeutic measures other than Vasti cleanses the body quicklyand easily, causes depletion and nourishment instantaneously and is free from anyadverse effect.77 Vasti is useful in Pangu, Urustambhs, Bhagna etc.78 Virechana and Vamana therapy no doubt causes elimination of doshas butit involves intake of recipe ingredients of which are pungent, sharp, hot etc.Thoseingredients causes’ unpleasantness eruption nausea cardiac discomfort and pain inthe gastrointestinal tract.79 Infants have immature tissue and less of strength, there is diminution andreduction in strength in old people. For both these category Virechana andVamana therapy is contraindicated. Asthapana type of Vasti can however begiven for elimination of doshas and nourishment of body. Vasti therapyinstantaneously promotes strength, complexion, sense of exhilaration andtenderness as well as unctuousness of body. 80Basti Effect: (1) Promotive aspects • Sustains Age. • Provides better life, improves strength, digestive power, voice and complexion. • Perform all functions • Provide firmness • Corpulence quality. • Lightness in viscera / systems because removes morbid matter from all over the body. • Restores normalcy. • Increases Relish (2) Curative aspect • Relieves Stiffness • Relieves contractions and adhesions. • Effective in paralytic conditions • Effective in dislocation and fracture conditionsEvaluation of Efficacy of Vaitaranabasti in Amavata-An observational Study 15
  34. 34. Basti karma • Effective in Those conditions where vata aggravated in Shakha / extremities. • Relieves pain • Effective in disorders of GI tract • Effective in diseases of Shakha and Kostha. • Effective in diseases of vital parts, upper extremities localized or general parts. • Beneficial to debilated and weak persons. • Arrest premature old age and the progress of white hair. (3) Preventive aspects • Beneficial in constipation. • Effective to purify various systems of the body.(4) Effect on dhatu: • Increases the quantity and quality of sperm • Effective to restore the normal functions of blood and other dhatus. • It provides strength by increasing muscle power. • Beneficial as geriatrics5) Effect on Brain and Psychology • Improves intellectual power • Provides clarity of mind • Improves clarity of sense organs • Induces sound sleep • Lightness • Exhilaration • Invigorates eyesight • Spright lightness of mind(6) Effective at any age and in any season • Basti is non antagonistic to healthy, diseased and old persons • Applicable in all seasons • Basti can be administered in child and older person too, because it is free from complications.Evaluation of Efficacy of Vaitaranabasti in Amavata-An observational Study 16
  35. 35. Basti karmaTypes of Basti Two types of basti • Niruha basti, Auvasana basti 81 • Niruha basti, Snehika basti 82 • Shita basti, Sukhoshna basti 83 Three types of basti • Asthapana basti, Auvasana basti, Uttara basti. 84, 85, 86 • Utkleshana basti, Shodhana basti, Shamana basti 87, 88, 89, 90 • Karma basti, Kala basti, Yoga vasti.91, 92, 93 • Vatahara basti, Pittahara basti, Kaphahara basti.94 • Sneha basti, Anuvasana basti, Matra basti.95 • Teekshna basti, Mrudu basti, Sadharana basti.96 • Kaphavatahara basti, Kaphapittahara basti, Pittaraktahara basti.97Four types of basti • Asthapana basti, Auvasana basti, Uttara basti Matra basti.98 • Pakvashayagata basti, Shiro basti, Kati basti, Vrana basti.Five types of Madhutailika basti 1) Madhutailika basti 99 2) Youktaratha basti 100 3) Doshahara basti 101 4) Siddha basti 102 5) Mustadiyapana basti.103Six types of Vasti [On the Basis of Rasa predominance in the Basti Dravya] 1) Madhura Rasa Skandha Dravya Basti 2) Amla Rasa Skandha Dravya Basti 3) Lavana Rasa Skandha Dravya Basti 4) Katu Rasa Skandha Dravya Basti 5) Tikta Rasa Skandha Dravya Basti 6) Kasaya Rasa Skandha Dravya BastiEight types of basti 104 1) Chatuprasruyika basti 2) Panchaprasruyika basti 3) Shatprasruyika basti 4) Saptaprasruyika bastiEvaluation of Efficacy of Vaitaranabasti in Amavata-An observational Study 17
  36. 36. Basti karma 5) Astaprasruyika basti 6) Navaprasruyika basti 7) Ekadasa Prasrta Basti 8) Dwadashaprasruyika basti.Ten types of Vasti [On the Basis of chief drug] 1) Ksira Basti 2) Mamsa Rasa Basti 3) Gomutra Basti 4) Rakta Basti 5) Kshara Basti 6) Dadhimastu Basti 7) Amlakamji Basti 8) Prasanna Krta Basti 9) Sura Krta Basti 10) Asava Krta Basti Fifteen types of basti 1) Vatahara basti 2) Pittahara basti 3) Kaphahara basti 4) Raktahara basti 5) Kaphavatahara basti 6) Kaphapittahara basti 7) Pittaraktahara basti 8) Pittavatahara basti 9) Pittaraktahara basti 10) Raktakaphahara basti 11) Raktavatahara basti 12) Vatapittakaphahara basti 13) Vatapittaraktahara basti 14) Kaphapittaraktahara basti 15) Vatapittakapharaktahara bastiEvaluation of Efficacy of Vaitaranabasti in Amavata-An observational Study 18
  37. 37. Basti karmaBrief introduction about some important Vasti a. Niruha Basti (Evacuative or Un-unctuous Enema): In Niruha Basti, Kashaya (decoction) is the predominant content. With the Kashaya, Madhu, Saindhava, Sneha and Kalka are the ingredients commonly used. Its synonyms are Asthapana Basti, Kashaya Basti etc. The Basti, which eliminates the vitiated Dosha from the body and increase the strength of the body because of its potency, is called Niruha Basti. 105 Because of this enema stabilizes the age (Vaya), stabilizes the normal functions of Dosha and Dhatu and stabilizes Deha i.e. strength of the body, is called Asthapana Basti .106 Depending upon drugs and preparations used in Basti it may be classified as follows: 107 Madhutailaika Basti Yuktaratha Basti Yapana Basti Siddha Basti b. Anuvasana Basti (Unctuous Enema): In this type of Basti only Sneha is used. According to the quantity of oil given, it is subdivide as follows: The Sneha Basti which will not cause any harm even if it is retained for one day and can be administered after taking food, therefore it is called Anuvasana Basti Sneha Basti 1/4th to the quantity of Niruha i.e. 6 Pala (298ml). Anuvasana Basti The quantity of Sneha is half of the Sneha Basti i.e. 3 Pala (144ml). Matra Basti This is the minimum quantity of Sneha Basti (½ of Anuvasana Basti) i.e. 1½ Pala (72ml). 108, 109,110Evaluation of Efficacy of Vaitaranabasti in Amavata-An observational Study 19
  38. 38. Basti karma B) Anatomical Classification: It depends upon the part of the body used for the administration of Basti.Internal application: • Pakvashayagata Basti • Uttara Basti a. Garbhashayagata Basti b. Mutrashayagata BastiExternal application: Vranagata Basti Kati Basti Shiro Basti Netra Basti C) According to the number of Basti to be used: Karma Basti - 30 Basti - 12 Niruha & 18 Anuvasna Basti Kala Basti - 16 Basti - 6 Niruha & 10 Anuvasana Basti Yoga Basti - 8 Basti - 3 Niruha & 5 Anuvasana Basti In the above types fixed sequence of Niruha and Anuvasana Basti is followed.Rectal Administration: Substances may be introduced into the rectum for exciting evacuation or for medication, which later may be intended for effect in three different locations. • For effects on the contents of the colon for which the term "endocolonic might be suggested to differentiate it from, • Effect to be exerted on the tissue of the colon, for which the term encolonic might be a suitable designation and • For administration by the way rectal medication intended for systemic action for which the term diacolonic might be employed. • Before one resorts to rectal administration it is a good rule to make a digital examination of the rectum.Evaluation of Efficacy of Vaitaranabasti in Amavata-An observational Study 20
  39. 39. Basti karma • Rectum distended with fecal matter should be cleaned out by an evacuate enema before it is given the task of receiving medication. • Rectal injections, also known as enemas, clysters or Lavements may be large or small.Why rectal administration?1. When it is desired to spare the stomach and intestine from the action of the drug or to protect the drug from the action of the digestive ferments.2. With children, who will not take disagreeable tasting medicaments, or with the insane, which refuse to swallow, rectal administration may become an important recourse.3. Such a bitter substance as strychnine can best be given to children in suppository form provided this method of administration is carried out gently, skillfully and tactfully.Enemas: Rectal injections, also known as enemas, clysters or lavements, maybe "large" or "small". An enema of less than half a liter might be considered a small enema and of more than half a liter is a large enema. 1. When a rectal enema is given by means of a syringe with a short tip, it is deposited just within the sphincter of the anus, a portion of the rectum that is normally very intolerant of sudden distention. It is indeed this irritability, which is responsible for the prompt evacuation of any fecal matter that arrives in this part of the bowel. For this reason, even a small quantity of fluid, when given rapidly, tends to cause evacuation. 2. When, on the other hand, the enema is administered very slowly, it suppresses evacuation reflex and reaches to the upper part of the colon which is not only more retentive but also more absorptive than the rectum. 3. After the drug once passes the anal sphincter, will pass easily up to the sigmoid and descending colon, across and down to the caecum regardless of the position of the body of the patient. Cool large enemas are believed to excite the gallbladder for contraction and are advocated in the treatment of catarrhal jaundice. Irritation of the colon is a long established form of treatment for the various types of jaundice. Garbat and Jacobi offer an experimental demonstration of the possible efficacy of this treatment. They found that within a period of from three or twelve minutes after the instillation ofEvaluation of Efficacy of Vaitaranabasti in Amavata-An observational Study 21
  40. 40. Basti karma various solutions high into the rectum a flow of bile was obtained from the duodenal tube that would continue for from eighteen to sixty minutes without any interruption. Hence, the introduction of various solutions into the upper part of the rectum produces drainage into the duodenum of bile that comes directly from the liver and without contraction of the gallbladder.(A) Evacuate enemas:1. Evacuate enemas in increasing order to potency, should be repeated every three or four hours, care being taken not to over distend the colon, until success is secured or the uselessness of the procedure becomes evident.2. Whether large or small, hot or cold, simple or medicated enemas should be employed to secure evacuation in any one case depends on the conditions present.3. If the rectum merely is to be emptied of feces, 0.5-liter enema given rapidly with the patient in the sitting posture suffices. If, on the other hand the most thorough possible cleansing of the bowel is aimed at (colonic flushing), the largest possible quantity of warm water from 1 to 2 liters is slowly introduced with the patient recumbent in the lateral or Sims position ; or, better still in the knee-chest position.4. On the other hand, a small (0.25 liter), cool enema rather quickly injected into the bowel, to stimulate it to evacuation, maybe considered one of the least objectionable procedures, even when employed quite habitually.(B) Oil enemas: Though oil enemas are essentially evacuant enemas, they are given with the technique of the retention enema, because they are to be retained for many hours, usually over night.Indications: 1. To soften feces, in constipation characterized by the formation of hard scybala and in that due to partial obstruction of the colon. 2. For evacuate action, in so-called spastic constipation, in pelvirectal constipation and in any other form of constipation and in which oral administration of cathartics is contraindicated by gastric disturbance. 3. for soothing action, in excessive irritability of the colon and rectum, in colitis and in proctitis.Evaluation of Efficacy of Vaitaranabasti in Amavata-An observational Study 22
  41. 41. Basti karma 4. It has been suggested that oil enemas might inhibit absorption of toxic products. That the oil has the power of removing substances soluble in it is shown by the fact that it is passed dark yellow or olive green and of offensive odour.There is no definite knowledge, however, of the degree to which this property might be of clinical value.Rules:1. The oil must be pure and free from rancidity. This is more important than that it come from a certain source. (Thus poppy seed oil, oil of sesame or cottonseed oil, when pure, is just as good for this purpose as olive oil).2. The oil should be placed in a basin of hot water until it has acquired blood heat (100 F).3. The oil enema is given at bedtime, unless it produces discomfort and interferes with sleep. In such case it may be taken early in the morning, and the patient may lie in bed for three or four hours after ward.4. The patient should understand that, unless the oil remains in the intestine for several hours at lest satisfactory results cannot be expected. The total quantity to be injected depends, therefore, on the patients ability to retain it.5. This is so variable that no definite quantity can be stated. The principle to be followed is to have the patient gradually increase the amount injected at successive times until a satisfactory amount can be introduced and retained.(C) Retention enemas: Technique: It is well to precede a retention enema by a cleansing enema, so as to unload the lower part of the bowel of fecal matter that may be contained in it, thereby lessening distention and favoring retention.1. The smaller in bulk the enema the better it is retained.2. Still, to be retained, it must also be quite devoid of irritating properties.3. The retention of an irritative substance may be favored by making its solution as nearly isotonic as possible, and by using colloidal fluid, such as starch water as diluents.4. If the fluid is introduced very slowly and steadily, the rectum does not become as readily aware of the distention and retains a quantity of fluid that would otherwise be expelled.Evaluation of Efficacy of Vaitaranabasti in Amavata-An observational Study 23
  42. 42. Basti karma5. Giving the enema at body temperature favors retention, as extremes of temperature excite peristalsis.6. The patient should assume the recumbent position for at least an hour after the injection, and should be instructed to resist any inclination to evacuation as much as possible.(D) "Nutrient" enemas: Why? The attempt has been made to maintain nutrition by rectal feedingwhen it is impossible or undesirable to introduce food into the stomach, or when itcannot be retained. But the colon has hardly any digestive power and it absorptivecapacity even for water-soluble substances of large molecular size is very poorand nil for fat.Rules:1. Not more than three nutrient enemas should be given in the twenty - four hours, at about eight hour intervals. The amount should at first not exceed 150 cc., to be gradually increased to 300 when given as ordinary enemas, though when given by proctoclysis the quantity may reach 1 liter.2. After each administration the patient should keep as quite as possible for at least two hours and suppress any desire to evacuate the bowel.3. In point of fact patients who need nutrient enemas should be kept in bed continuously; at rest in bed lessen the consumption of calories by at least 25 per cent.4. A daily cleansing enema is advisable. This should precede the nutrient enema by about an hour.(E) Medicated enemas: Medicated enemas are given by the technique of retention enemas. Theymay be employed, as previously stated, for endocolonic, encolonic or diacolonicaction. Oil may be used as a vehicle for diacolonic administration of oil-solublevolatile bodies. On the basis of extensive experience by Gwathmey.Thus from above description we can easily understand the role of madhu,saindhav and sneha in each basti. Above description resembles to the Ayurvedicdescription of basti karma up to maximum extent. Though modern sciencedeveloped other advanced routes for the drug administration so now days they arenot using this route but they cant deny the importance of this routeEvaluation of Efficacy of Vaitaranabasti in Amavata-An observational Study 24
  43. 43. AmavataDisease Review Amaravata describes a wide range of joint disease manifestations.Amavata is mainly caused by two factors ama and vata.Etymology of Amavata 1. ‘Amena samhita vata Amavata’. The virulent Ama circulates in the whole body propelled by the vitiated vata dashas producing block in the body channels that stations itself in the sandhi giving rise to Amavata.111 2. The combinations of ‘Ama’ and vata form Amavata. It shows the Pridomminance of Ama & vata in the samprapti of Amavata. 112 3. Ajeerna produce ‘Ama’ & along with vata it produce Amavata.113Definition ‘Ama’ is produced by agnimandya of both Jatharagni and Dhatwagnis.Even though ama is a cause for various diseases, in Amavata it is the maincausative factor. Ama and vata vitiated simultaneously and disease is manifestedmainly in joints of hasta, pada, sira, trika, gulpha, janu and uru. The mainsymptioms produced are Angamarda Aruchi, Trishna, Alasya, Gouravam, Apaka& Shotha 114Role of Ama in Amavata The main causative factor for the manifestation of Amavata is Ama. So itis necessary to know about the Ama in detail.Etymology of Ama 1. The unprocessed or undigested food partical is Ama. 115 2. Ama means, “Which is subject of digestion”.116Definition of Ama 1. The first Rasa dhatu, which has been inadequately digested due to the weakness of digestive fire and accumulating in the stomach in the abnormal state, is know as Ama 117, 118 2. The undigested Adya Ahara dhatu is Ama.119 3. The food material which will not undergone vipaka, leads to Durgandha, which is large in quantity, which is picchila & which leads to Gatra Sadana is called Ama. 4. Due to impairment of digestive fire the undigested remained food material is ‘Ama’.Evaluation of Efficacy of Vaitaranabasti in Amavata-An observational Study 25
  44. 44. Amavata 5. Apakva Anna Rasa is Ama & some other considers the accumulation of mala as Ama & still other opines the first stage of vitiation of dosa as Ama.On the basis of the for going, Ama may be classifieds as below I) Ama produced due to hypo functioning of Agni i.e 1) Ama due to Jatharagni Mandya. 2) Ama due to Dhatvagni Mandya. 3) Ama due to Bhutvagni Mandya. II) Ama produced irrespective of the action of Agni 1) Accumulation of mala. 2) Ama due to interaction & virulently vitiated dosas 3) First phase of dosic vitiation.Vata in Amavata Voluntary & involuntary functions are all under the control of Vaya. InAmavata the normal function of Vata is disturbed. It produces stabdhata &sandhigraha leading to the restricted movements of joints & it will become theresponsible for crippling effect seen in the patients. This shows that predominanceof vata dosa in the pathogenisis of Amavata. Now let us carry a brief description of vata dosa. The word vata derivedfrom “Va gati gandhanyoh” it means to move, to make known, and to enthuse.120It has got the other synonyms like Anila, Maruta, Pavana etc. 121Gunas of Vata Ruksha, Seeta, Laghu, Sukshma, Chala, Visada, Parusha & Khara 122, 123Functions of Normal Vata Vaya sustains the body with expiration, inspiration, enthusiasm, movement ofvarious parts. Kneenees (sharpness) of sense perception, initiation of the naturalurges and many other functions.124 1. Tantrayanradhara 2. Cheshta Pravartaka 3. Mano Niyanta & Praneta 4. Sharvendriya Uttyojaka 5. Sharvendriya Artha Abhivodha 6. Sharva sharira dhatu Vyuhakara 7. Sharira Sandhanakar 8. Vak pravartakaEvaluation of Efficacy of Vaitaranabasti in Amavata-An observational Study 26
  45. 45. Amavata 9. Sabdasparsa Prakrti 10. Srota sparsana mula 11. Harsha utsahayoni 12. Agni samirana 13. Mala ksepta 14. Grabhakrti Karta 15. Ayusha Anuvratti 125 Importance of Vata Pitta, Kapha, Dhatu & Mala are movementless, unless they are brought to the proper place by vata to carry out their functions. Thus Vayu makes the functions of all the tissues of body 126 Symptoms produced due to Ama 1. Srotordha 2. Balabramasa 3. Gaurava 4. Anila Mudhata 5. Alasya 6. Apaki 7. Nisthivana 8. Mala sanga 9. Aruchi 10. Klama 11. Vit, Mutra, Nakha, Dhatu, Chakshu Pitata/Raktata/Krishnata 12. Prusthtasthi, Katisandhi Ruk 13. Siroruk 14. Nidra 15. Mukhavairasya 16. Jvara 17. Atisara 18. Romaharsa. Symptoms of Vataprakopa 127 1. Parava Samkocha 2. Stambha 3. Asthi Paravabheda 4. Lomaharsa, Pralapa, Hasta-Pristha-siro-grahaEvaluation of Efficacy of Vaitaranabasti in Amavata-An observational Study 27
  46. 46. Amavata 5. Khanjata-Pangulya 6. Kubjata 7. Sosha 8. Anidra 9. Grabha-sukra-Rajonasa 10. Spandana 11. Gatra Suptata 12. Sira, Nasa, Akshi, Jatru, Grivahanunam-Bheda ,Toda-Arti 13. Akshepa 14. Moha 15. Ayasa Nidana of Amavata Nidana is defined as the factors which deranges the dynamic state of doshic equilibrium provokes the disease is known as Nindan. This Nidana helps us to decide the line of treatment as well as prognosis of the disease. Amavata Ninda is of multifaceted various Acharya’s mentioned their different views for the productions of Ama in Amavata. Madhavakarhas128 delt the separate Nidana as 1. Viruddha Ahara (Incompatible food) 2. Viruddha Chestha (Incompatible food) 3. Mandagni (Hypofunctiony of agni) 4. Nischala (Lack of exercise) 5. Snigdha Ahara followed by immediate exercise. Besides these intakes of Kanda, mula and sakha and excessive exertion are itiological factors opeined by Harita 129 In Anjana Nidana which vititate vata, pitta and kapha are considered under Nidana.130 These all above Nindan can be included under two heading 1). Unwholesome diet & 2).Erroneous habits. Unwholesome diet means “which aggravates the body humors but not expel them out of the body”.131 Charaka has mentioned 18 types of 132 unwholesome diet (Viruddha Ahara) some of the virudha Ahara are as follows 1. Milk along kulatha, 2. Panase fruit with matsyaEvaluation of Efficacy of Vaitaranabasti in Amavata-An observational Study 28
  47. 47. Amavata 3. Mixtures of equal quantities of honey & ghee. 4. Boiled curd 133 Erroneous habits (Viruddha chesta) mainly included alternate use of coldand heat, suppression of natural urges, sleeping daytime, walking at night, overindulgence in work.Table No 1,: Amavata Nidana according to various Acharyas.Sr Nidana M.N. H.S. A.N. i. Viruddha ahara + - - ii. Guru ahara - + - iii. Tarpite kandashakastu - + - iv. Mandagni + + - v. Viruddha cheshta + - - vi. Avyayama + -vii. Snigdha bhuktavato hiannam vyayama + - -viii. Swa prakopnaiha : - - + Vatadosha Pittadosha Kaphadosha ix. Vyavayina - + -Samprapti of Amavata 134 The impairment of Agni will produce the condition of Ama. MainlyAgnimandya initially affects digestion followed by metabolism. Hence in thisstate of Agni, the Rasadhatu is not formed up to the standard level & it isconsidered as Ama. This ‘Ama’ along with Vyana Vayu and also by virtue of itsVishakari guna it quickly moves to all kapha sthanas, through Hridaya andDhamanes. This Vidhagada Ama, in kapha sthana is further contaminated bydosas and assumes different colours, because of the Atipichhilata. If Ama gets obstructed in to channels and promotes further vitiation ofvata dosha, this morbid Ama circulates ubiquitously in the body propelled byvitiated vata with predilection for shesma sthana. On the dhamanies with the otherdosas it facilitates sroto abhisyanda and srotorodha causing sthanasmsrayamanifested stabdhata (stiffness), sandhisula (joint-pain), sandhishotha (swelling),Evaluation of Efficacy of Vaitaranabasti in Amavata-An observational Study 29
  48. 48. AmavataAnga marda(body ache) Apaka(indigestion), Jwara (fever), Anga gourava(heaviness of body), Alasya(laoghess) etc symptoms of Amavata. According to the commentators on Madhava Nidana the Samprapti ofAmavata can be summarized accourding to ShatkriyakalSanchaya & Prakopa: When a person is exposed to aetiological factors likeViruddha Ahara, does vyayama after intake of snigdha ahara, Chinta, Krodha etc.,Agnimandya is there leading to Tridoshadushti and Amotpatti in the Sanchayaand Prakopavastha.Prasara: With the help of Vata (Biophysical mechanism), this Ama gets Prasarato shleshma sthana producing mild sandhishoola etc. along with Ama symptoms.Then Ama gets interacted with Tridosha and further modified (Vidagdha) to greatextent and yagapatakupitavanta of Ama and Vata takes place via Rasavaha srotasa(Dhamani).Sthana Sanshraya: This prasarita Ama, which viscid, unctuous and guru enduresSthana Sanshraya in Hridaya, Trika Sandhi and Sarvanga (Srotoabhishyanda)leading to Dosha-dushya Sammurchchana. Primarily the disease is not manifestedcompletely, so only initial mild symptoms like Aruchi, Apaka etc. are observedwhich can be considered as purva rupa of the disease Amavata.Vyakti: As it reaches vyakti stage most of the symptoms of Amavata aremanifested like Vrishchika dashavata vedana, stabdhata etc. In Adibala Pravritacases (Karmajanya, Mata-pita apcharajanya etc.) Khavaigunya is already thereand with the minor nidana sevana disease in manifested.Bheda: In chronic stage or if the disease is left untreated it reaches bhedavastha-producing updrava like Sankocha, Khanjata etc.The Samprapti Ghatakas, which are involved on the Amavata, are as follows. 1. Dosha-Tridosha mainly vata(vyana, samana, Apana) and kapha ( Kledaka, Bodhaka, slemaka) 2. Dhatu -Rasa, Mamasa. Asthi, Majja. 3. Upadhatu -Snayu and Kandara. 4. Srotases -Annavaha, Rasavaha, Asthivaha, Majjavaha. 5. Srotodusti -Sanga, Vimaragagmana. 6. Udbharasthana- Amashya (Ama), Pakvasaya (vata). 7. Adhisthana -whole body 8. Vyaktasthana -Sandhi 9. Avayava -Sandhi.Evaluation of Efficacy of Vaitaranabasti in Amavata-An observational Study 30
  49. 49. Amavata 10. Vyadhiswabhava -Mainly Ashukar. 11. Sanchara Sthana -Hridya, Dhamani. 12. Roga Marga -Madhyama roga marga 13. Agni -Jataragni Mandya, Dhatwagni Mandya. FLOW CHART-1 SAMPRAPTI Virudha Ahara + Virudha Vihara Agnidusti in Amashaya Formation of Amarasa Sanchara through Dhamani all over The body by vata dosha Samadosha Accumulates in the Slesma sthanas like Amashaya, Sandhi etc Enters Into Kosta, Trika Sandi Leads to Gatra Stabdata Karoti Sarujam shotam Yatra doshaha prapadyate Leads to painful swelling of joints wherever the vikrita dosas travels. Angamarda, Aruchi, Apaka, Gourava, Jwara, Sandi Ruja Sandi shota Amavata.Evaluation of Efficacy of Vaitaranabasti in Amavata-An observational Study 31
  50. 50. AmavataPurva roopa of Amavata In the classics it is not clearly mentioned purva roopa of Amavata. But however in such condition Avyakta lakshana prior to the manifestation of 135 disease is considered as the purva poorpa with the help of this the purva roopa of Amavata can be considered as follows 1. Dourbalyam (Weakness) 2. Haridaya gourava (heaviness in chest) 3. Gatra stabdam (Stiffness of the body) 4. Apaka (indigestion) 5. Anga mardu (Aching all over body) 6. Gourava (Heaviness) 7. Aruchi (loss of taste) 8. Alasya (lack of enthusiasm) 9. Jwara (fever) 10. Sandhi vedana (Joint pain)Roopa of Amavata “Utpanna Vyadhi bhodakameva lingam rupam” 136 It means which gives the idea about the manifested disease is known as ‘Rupa’. 137 Madhavakara while describing Amavata lakshana, he has considered them in to two heading one is samanya lakshana another is lakshana samachaya of pravrudhu Amavata. Samanya Laxanas are as follows 1. Angamarda (body ache) 2. Aruchi (Tastelessness) 3. Trishna (Thirst) 4. Alasya (lack of enthusiasm) 5. Gouravam (Heaviness all over body) 6. Jwara (Fever) 7. Apaka (Indigestion) 8. Shunata Anganam (Swelling all over the body mainly in joints)Pravriddha Lakshana of Amavata: It is the advanced stage of disease and very troublesome to patients aswell as for physicians. According to Kriyakala and stage wise development, it isthe worst stage of disease. Articular and Extra-articular feature present in thisEvaluation of Efficacy of Vaitaranabasti in Amavata-An observational Study 32
  51. 51. Amavatastage have been elucidated by Acharya Madhavakara, Bhava Mishra and YogaRatnakara.According to Madhavakara 1381. Sarujam Sandhishotha – Hasta, Pada, Shiro, Gulpha, Janu, Uru Sandhis are chiefly involved in Amavata.2. Vrishchika danshavata vedana – This kind of pain shows the presence of Ama at the site of pain.3. Utsahahani – A subjective feeling in which lack of enthusiasm can be seen in suffering person. It is due to insufficient nutrition of Sharira Dhatus, Indriya and Mana.4. Bahumutrata – Presence of vitiated or dushita Ama causes sroto – abhishyanda in the body, which leads to increase of kleda. This Bahumutrata occurs for the excretion of excess kleda from the body.5. Kukshikathinya – Vitiated Samana and Apana Vata along with the Ama leads to Kukshikathinya, which is the rigidity of abdomen.6. Kukshishoola – Srotorodha due to Ama causes obstruction to normal movement of vitiated samana and apana Vata resulting in pain in abdomen.7. Nidra Viparyaya – Due to vata vriddhi, pain gets aggravated at night and keeps the patients awaken which leads to Nidra Viparyaya.8. Chardi 139 Continuous formation of dosha leading to excitation of Amashaya byVata causes Chhardi.9. Bhrama - Presence of Kapha in Srotas and Vitiated Vata causes Bhrama.10. Murchcha - Inability of the sensory organs to perceive the sense objects is Murchcha. Loss of motor function occurs in Murchcha due to upatapa of Indriya by Vitiated Vatadi doshas 14011. Hritgraha - It is due to Rasavaha srotodushti (its mulasthana is Hridaya) and vitiation of Samana Vata, Vyana Vata and Avlambaka kapha. Hritgaurava is also produced due to above reason when vitiation is mild.In R.A. cardiac manifestations like Pericarditis, Myocarditis, Conduction defects etc. can occur.Evaluation of Efficacy of Vaitaranabasti in Amavata-An observational Study 33
  52. 52. Amavata12. Vibandha – It is due to vitiated Apana Vata and improper degradation of Ahara into Sara and Kitta.13. Antrakujana – In this feature, increased bowel sounds are present due to movement of Vitiated Vata in the intestine.14. Anaha – It is the stagnation of vitiated vata in Kukshi.15. Agnimandya – Vicious cycle of disease (Agnimandya-Shuktatva – Annavisha) produces Agnimandya again and again.16. Praseka – It means lalasrava. 141Excessive thick, mucoid, salivary secretions are produced due to Samarasa, which shows Rasavaha and Udakavaha srotodushti.17. Gaurava – Due to Vitiated Kapha there is feeling of heaviness in Hridaya and body parts preferably in Joints.18. Vairasya 142 Perception of different taste than normal due to Sama Rasa and vitiated Bodhaka Kapha.19. Daha - Due to Vitiation of Pitta sometimes localized or generalized Daha occurs. Warmth of the joint is usually evident on examination. In its most aggressive form, rheumatoid vasculitis can cause Mononeuritis multiplex (Harrison 1994).20. Trishna – Trishna is due to Agnidushti, Sama Pitta and Vata. It shows Rasavaha, Udakavaha srotodushti in disease process.Table No.2 Similarity between Amavata and Rheumatoid ArthritisRheumatoid Arthritis AmavataMorning stiffness Gatra sthabdata or sandhi sthabdataArthritis of 3 or more joints Bahu sandhi shothaArthritis of hand joints Hasta, sandhi shothaSymmetrical arthritis Bahu sandhi shotha (ubhaya) Angavaikalya Rheumatoid nodule Rheumatoid factor ----Radiological changes ----Evaluation of Efficacy of Vaitaranabasti in Amavata-An observational Study 34
  53. 53. Amavata The first 4 criteria of RA can be correlated with the inflammatorycondition of amavata. But rheumatoid factor and radiological changes cannot becorrelated to any conditions of amavata. Hence on symptomatology amavata canbe best correlated to RA.Pratyatma Lakshana (Cardinal Signs and Symptoms) Pratyatma Lakshanas are main clinical features on which the disease canbe clearly differentiated from other identical forms of disease. In Amavata,sandhis are the main site of manifestation of clinical features, thus joint associatedsymptoms are considered as Pratyatma lakshana of disease Amavata.These are as follows:(a) Sandhi Shoola (Joint Pain) In Amavata, Vitiation of Asthi and Majjagata Vata causes pain inSandhis and in severe stage, it is found as Vrishchika Dansha vata. The most common manifestation of established R.A. is pain in affectedjoints, which is aggravated by movements. During rest and especially earlymorning stiffness are also characteristic features of R.A. Pain originatespredominantly from joint capsule, which is abundantly supplied with pain fibresand is markedly sensitive to stretching or distension (Harrison 1994).(b) Sandhi Shotha (Joint Swelling) Sandhi Shotha (Ekangika shotha) results when vitiated dosha afflicts 143Twaka, Rakta, and Mamsa in joints Madhavakara has described that shotharesult due to the affliction of Ama and Vata Pradhana Tridosha in joints. Joint swelling in R.A. is the result of accumulation of synovial fluid,hypertrophy of synovium and thickening of joint capsule.(c) Stabdhata (Stiffness) The restriction or loss of movements of joints. Gatra stabdhata iscaused due to spreading of Ama through out the body by vitiated Vata.144, 145 In majority of patients, the onset is insidious with joint stiffness,especially early morning stiffness, which gradually gets reduced by evening. Thisdiurnal rhythm worse on arising in the morning and than relieving towardsevening probably reflects the diurnal variation in plasma cortisol level.Evaluation of Efficacy of Vaitaranabasti in Amavata-An observational Study 35
  54. 54. Amavata(d) Sparshasahyata (Tenderness) Sparshasahyata can be included in Sandhishoola in which patient crieswith pain even when the gentle pressure is applied to affected part. Some timesperson himself cannot touch the affected part due to pain. According to Modern text pain on movement and tenderness are thecardinal signs of the disease (Becron -1971).Table-No 3,Lakshans According to different Ayurvedic classics 146,147,148,149,150 No. Lakshana MN B.P. B.R. Y.R. G.N. A.N 1 Agnidourbalya + + - + + - 2 Alasya + + - + + 3 Anaha + + - + + - 4 Angamarda + + - + + - 5 Anga sonata + + - + + - 6 Antra kujan + + - + + - 7 Apaka + + - + + - 8 Aruchi + + - + + - 9 Bahu mutrata + + - + + - 10 Bhrama + + - + + 11 Chardi + + + + + - 12 Daha + + - + + - 13 Gourava + + - + + - 14 Hritgraha + + - + + - 15 Janghadi Pradesha Vyadha - - + - - - 16 Jwara + + - + - 17 Kukshi Kathinyata + + - + - 18 Kukshi sula + + - + - 19 Murcha + + - + 20 Nidra Viparayaya + + - + 21 Pandu Varna - - + - - 22 Prasekam + + - + + - 23 Sandhi gourava + - - - + + 24 Sandhi Ruja + + - + + +Evaluation of Efficacy of Vaitaranabasti in Amavata-An observational Study 36
  55. 55. Amavata 25 Sandhi shotha + + - + + + 26 Sandhi Graha - - - - - - 27 Sosha - - + - - - 28 Trishna + + + + + - 29 Ushnata - - + - - - 30 Utsaha Hani + + - + + - 31 Vairasyam + + - + + - 32 Vishuchi - - + - - - 33 Vitvibandha + + - + + - 34 Vruschika damsavata peeda + - - - + -Table No.4, Showing the Sthananusara Laxana Stanika Laxana Shareerika Laxanas Manasika LaxanaSandhi shotha, Sandhi Angamarda, Kukshishoola, Aruchi, Utsahahani,shoola, Gatra Bahumutrata, Trusna, Peeta mutrata, Moorcha,sthabdata, Daha, Raga, Alasya, Takratulyata, Gourava, Bhrama, Alasya.Kandu. Nidraviparyaya, Jwara, Antrakoojana, Apaka, Anaha, Agnimandya, Grahanidosha, Praseka, AsyavairasyaSapeksha Nidana Sapeksha nidana becomes necessary when two or more disease have a fewimportant laxanas similar to each other and in such condition in order to avoid anyerror in adopting the line of treatment. The differential diagnostic is done on thebasis of few points such as difference in samprapti accompanying laxanas,upashaya anupashaya etc. Here the disesae, which was exhibited with sandhi shotha andsandhishoola specially, are considered for differential diagnosis. 1) Vatarakta 2) Sandhigatavata 3) Krostaka sheersha 4) Sandhiga sannipata 5) Sandhi aghataEvaluation of Efficacy of Vaitaranabasti in Amavata-An observational Study 37

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