Virechana vasti amavata-pk017-gdg


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A Comparative Study of Virechana karma and Basti karma in Amavata W.S.R.T. Rheumatoid Arthritis, By Suresh N. Hakkandi Department of Panchkarma, D.G.M. Ayurvedic Medical College, Hospital and P.G. Research Center, Gadag.

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Virechana vasti amavata-pk017-gdg

  1. 1. “A Comparative Study of Virechana karma andBasti karma in Amavata W.S.R.T. Rheumatoid Arthritis” By Suresh N. HakkandiDissertation 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. (PANCHAKARMA) In PANCHAKARMA Under the guidance of Dr. G. Purushothamacharyulu, M.D. (Ayu) And co-guidance of Dr. Shashidhar.H. Doddamani, M.D. (Ayu) Post graduate department of Panchakarma, Shri D. G. Melmalagi Ayurvedic Medical College, Gadag – 582103. 2006.
  2. 2. Rajiv Gandhi University Of Health Sciences, Karnataka, Bangalore. DECLARATION BY THE CANDIDATE hereby declare that this dissertation / thesis entitled “A ComparativeStudy of Virechana karma and Basti karma in Amavata W.S.R.T. Rheumatoid Arthriyis”is a bonafide and genuine research work carried out by me under the guidanceof Dr. G. Purushothamacharyulu, , Professor and H.O.D, Post- M.D. (Ayu)graduate department of Panchakarma and co-guidance of Dr. Shashidhar. H.Doddamani, , Assistant Professor, Post graduate department of M.D.(Ayu)Panchakarma.Date: Suresh N. HakkandiPlace: Gadag.
  3. 3. CERTIFICATE BY THE GUIDE This is to certify that the dissertation entitled “A ComparativeStudy of Virechana karma and Basti karma in Amavata W.S.R.T.Rheumatoid Arthritis” is a bonafide research work done by Suresh N.Hakkandi in partial fulfillment of the requirement for the degree of AyurvedaVachaspathi. M.D. (Panchakarma).Date:Place: Gadag Dr.G.Purushothamacharyulu, M.D. (Ayu). Professor & H.O.D Post graduate department of Panchakarma.
  4. 4. ENDORSEMENT BY THE H.O.D AND PRINCIPAL OF THE INSTITUTION This is to certify that the dissertation entitled “A ComparativeStudy of Virechana karma and Basti karma in Amavata W.S.R.T.Rheumatoid Arthritis” is a bonafide research work done by Suresh N.Hakkandi under the guidance of Dr.G. Purushothamacharyulu, M.D. (Ayu),Professor and H.O.D, Postgraduate department of Panchakarma and co-guidanceof Dr. Shashidhar.H. Doddamani, M.D. (Ayu), Assistant Professor, Post graduatedepartment of Panchakarma.Dr. G. Purushothamacharyulu, M.D. (Ayu) Dr. G. B. Patil. Professor & H.O.D, Principal.Post graduate department of Panchakarma.
  5. 5. 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: Suresh N. HakkandiPlace: Gadag.© Rajiv Gandhi University of Health Sciences, Karnataka.
  6. 6. Abstract Virechanakarma and Bastikarma are the most important among thePanchakarmas. It has already been proved that the karmas are beneficial in managingthe Amavata, and it is the most common joint disorder worldwide. The study “A Comparative Study of Virechana karma and Basti karma inAmavata W.S.R.T. Rheumatoid Arthritis” is focused on important techniques i.e.Nittyavirechana and Yogabasti and also common clinical entity Amavata.Nittyavirechana with Eranda tial and Yogabasti with Erandamooladi niruha andBrihatsandhavadi anuvasana are believed to have a appreciable role in themanagement of such crippling nature, reptitive attacks and chronic course ofAmavata. The objectives of this study are 1] To evaluate the effect of Nittyavirechana inAmavata 2) To evaluate the additive efficacy of Yogabasti in Amavata3) To evaluatethe comparative effect of Nittyavirechana and Yogabastib in Amavata The aim of this study was to find out the effect of Nittyavirechana andYogabasti in the management of Amavata, and to check the comparative effect inmanaging the same disease. Therefore, two groups were made and the results obtainedin both the individual groups were compared. The study design selected for thepresent study was prospective comparative clinical trial. In group A (Nittyavirechana) 01 patients (6.66%) had good response to thetreatment and 11 patients (73.33%) had moderate response to the treatment and03(20%) patients show mild response after the treament.
  7. 7. In group B (Yogabasti) 6 patients (40%) had good response to the treatmentand 9 patients (60%) had moderate response to the treatment. Among the group A andB the parameters Gulph, Pada and Uru shows highly significant, where as otherparameters are not significant in the comparative study (By using unpaired t-test,p<0.05). At the same time overall treatment response was better in the Nittyavirechanaand Yogabasti. This suggests that there was considerable improvement in both thegroups but Yogabasti group got more beneficial effects. 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, properties should be used in this disease. Nittyavirechana impartsAgnideepana, Vatanulomana and opens up the srotas in the shareera facilitating morenourishment and free movement of Vata dosha. Yogabasti is prime treatment forAmavata in turn plays vital role in correcting pathology of the disease and givesremarkable results. This results in the relief of symptomatology of the disease, by acting locallyand systematically. Ingredients of Eramdamooladi niruhabasti and Brihatsaindhavaditail possess properties such as Vedanashamaka, Shotahara Lekhana and alsoVatanulomaka. There by, it is an ideal treatment of choice in Amavata.Key words: - Nittyavirechana, Yogabasti, Amavata, Rheumatoid Arthritis,Vaishwanara choorna Eranda tail, Eeandamooladi niruha, Brihatsaindhavadianuvasana.
  8. 8. Acknowledgement One of the great pleasure of life is doing the things that others says youcannot do it, by the grace of god, bless of eiders I take this opportunity to express myregards to the persons who helped in completing this work. I express my deep sense of gratitude to his great holiness Jagadguru ShriAbhinava Gavisiddheshwara mahaswamiji for their divine blessings. Words fail miserably when I try to express my gratitude to my mentor, myguide Dr.G.PurushottamacharyluM.D(Ayu), H.O.D of P.G.Department ofPanchakarma. For his incessant, untiring, round the clock guidance with all thediligence. His sustained fostering and encouragement instilled considerableimpetus in me enabling to achieve this milestone which otherwise would havelacked this particular finish. Indeed, I will cherish the affectionate guidance of my co-guideDr.Shashidhar H.Doddamani M.D (Ayu), Asst professor of P.G.Department ofPanchakarm. For his invincible and radical thinking were very valuable inachieving this research work invoking scientific spirit throughout the course of thestudy. I express my sincere and deep gratitude to Dr.G.B.Patil, Principal,D.G.M.A.M.C, Gadag, for his wholehearted encouragement as well as providing allnecessary facilities for this research work. I express my sincere gratitude to Dr.P.Shivaramudu M.D (Ayu), AssistantProfessor and Dr. Santhosh.N.Belavadi MD (Ayu), Lecturer of P.G.Department ofPanchakarma for his excellent advices. I also express my sincere gratitude to Dr.S.D.Yargeri R.M.O. for his moralsupport and special care in providing the all the facilities during this trail work. I express my sincere gratitude to Dr.V.Varadacharyulu, Dr.M.C.Patil, Dr.Mulgund, Dr.Dilip Kumar, Dr.R.V.Shetter, Dr. K.S.R.Prasad, Dr.G.Danappa Gowdar,Dr. Kuber Sankh, Dr.J.G.Mitti, Dr.Sheshikanath.Nidagundi, Dr. Samudri and otherPG staff for their constant encouragement. I thank Dr. B. G. Swami, Dr.U.V.Purad, Dr.B.M,Mulkipatil and otherundergraduate teachers for their support in the clinical work. I thank to Shri.Nandakumar (Statistician), Shri.V.M.Mundinamani (Librarian), Mr.Surebana andother hospital and office staff for their kind support during my study.
  9. 9. Indeed, I will cherish the affectionate of my Father, my Mother, my wifeDr. Pratibha, my son Satvika, my sister Jayashree, brother-in-law Sharanappa, mybrother Shambanna Bavihalli and all my family members who have been a source ofinspiration for my entire carrier. I cardinally thank Dr. B. S. Savadi, Dr. Sambayya, Dr. K. B. Hiremath, Dr. A.S. Patil, Dr. C. S. Karamudi, Dr. S. S. Shiruramath, Dr. Srikant P.L., Dr Rudrakshi,Dr. S. R. J., Dr. Manohar, Dr. S. M. Patil, Dr. B. V. Desai, Dr. Hunagund, Dr. SyedPasha, Raghavendra Kulakarani and other staff of S. J. S. Ay. Medical collegeKoppal. I express my sincere thanks to my friends Dr.Babu Menon, Dr.Dattu Vijapur,Chandranna M., Ramesh Gadad, Anand Ballary, Dr.Santhosh.L.Y, Dr. Subin, Dr.Sateesh, Dr. Febin, Dr. Varsha, Dr. D. S. Swami, Dr.V.M.Hugar, Dr.JayarajBasarigidad, Dr.Venkaraddi, Dr.B.L.Kalmath, Dr.P.Chandramouleeswaran,Dr.Shaila.B. Dr.Uday Kumar, Dr.Ratna Kumar, Dr.Ghanti, Dr.Pradeep, Dr.Sobagin,Dr.Manjunath.Akki, Dr.G. G. Patil, Dr.Ashwindev, Dr.V.S.Hiremath,Dr.L.M.Biradar, Dr.Jagadisha.H., Dr.Sharanu, Dr. Krishna J. Dr. Shivakumar Sarvi,Dr.Anand, Dr.Umesh, Dr.Suvarna, Dr. Anita Dr.Devendrappa, Dr.Sibaprasad,Dr.Madhushree, Dr.Ashok.M.J, Dr.Payappagoudar, Dr. Prasanna, Dr. Nataraj, Dr.Udayaganesh, Dr. Adarsha, Dr. Shailej, Dr. Muktha and other post graduate scholarsfor their support. I would like to mention the support and inspiration provided by my Father-in-law Shri.Shantappa Budihal & family for their support and encouragement during mystudy. I acknowledge my patients for their wholehearted consent to participate in thisclinical trial. I express my thanks to all the persons who have helped me directly andindirectly with apologies for my inability to identify them individually. Finally I dedicate this work to my respected parents Shri. N. S. Hakkandi,Smt. F. N. Hakkandi and my wife Dr. Pratibha who are the prime reasons for allmy success.Date: Signature of the scholarPlace: (Dr.Suresh N. Hakkandi)
  10. 10. TABLE OF CONTENTS Chapters Page No. 1. Introduction 1-4 2. Objectives 5 3. Review of literature 6-85 4. Methodology 86-104 5. Observation and Results 105-136 6. Discussion 137-154 7. Conclusion 155-156 8. Summary 157-158 9. Bibliography 159-171 10. Annexure
  11. 11. List of tablesTable No. Page No.1. Showing bhoutik composition of virechana dravya 142. Showing doses of Virechana drugs according to Sharangdhara 193 showingvirechana matra according Koshta 194 showing Assessment parameters of Virechana 205 showing Samyak Yoga Lakshana of Virechana 216 showing Virechana Vyapat 217 Showing Amavata Nidana according to various Acharyas 498 Showing the similarity between Amavata and Rheumatoid Arthritis 569 showing lakshans According to different Ayurvedic classics 5810 Showing the Sthananusara Laxana 5911 showing various Upakramas have been prescribed by different 68 Acharyas for the treatment of Amavata:12 showing extra articular features of RA 7913 showing differential diagnosis regarding with Amavata 8114 Showing the Composition and Properties of Vaishwanara Churna 8815 Showing the Properties of Drugs of Brihat Saindhavadi Taila 8916 showing Erandamooladi Vasti Dravyas 9117 showing distribution of patients by age groups 10618. Showing distribution of patients by Sex 10719 showing distribution of patients by religion. 10820 showing distribution of patients by occupation. 10921 showing distribution of patients by socio-economical status 11022 showing distribution of patients by dietary habits. 11123 showing the distribution of patients by duration of disease 11224 showing the distribution of patients by treatment history 11325 showing distribution of patients by nature of Koshta. 11426 showing distribution of patients by Jatharagni. (Status of Jatharagni). 11527 showing distribution of patients by nature of Mala pravritti 11628 showing distribution of patients by type of Desha. (Nature of Habitat). 11729 showing distribution of patients by Vyasana. (Addiction). 11830 showing the distribution of patients by Nidra in both Groups. 11931 showing the distribution of patients by Deha prakriti in both Groups. 12032 showing the distribution of patients by Satmya. 12133 Showing the presence of RA factor in both group 12234 Showing the presence of ASLO titer in both group 12335 Showing the presence of CRP titer in both group 12436 Showing the types of Amavata in both groups 12537 Showing the distribution of patients by Mode of onset in both Groups. 12638 showing distribution of patients by Nidana 12739 showing the distribution of symptoms of Amavata in both Groups 12840 Showing the over all effect of treatment in both Groups. [ last graph] 129
  12. 12. 41 showing Data related to the response of treatment in group A 13142 showing Data related to the response of treatment in group B 13243 showing statistical analysis of subjective and objective 133 parameters in group A44 showing statistical analysis of subjective and objective 134 parameters in group B45 showing the comparative statistical analysis 135 of subjective and objective parameters in both groupsList of graphs1 showing distribution of patients by age groups 1062. Showing distribution of patients by Sex 1073 showing distribution of patients by religion 1084 showing distribution of patients by occupation 1095 showing distribution of patients by socio-economical status 1106 showing distribution of patients by dietary habits. 1117 showing the distribution of patients by duration of disease 1128 showing the distribution of patients by treatment history 1139 showing distribution of patients by nature of Koshta. 11410 showing distribution of patients by Jatharagni. (Status of Jatharagni). 11511 showing distribution of patients by nature of Mala pravritti 11612 showing distribution of patients by type of Desha. (Nature of Habitat). 11713 showing distribution of patients by Vyasana. (Addiction). 11814 showing the distribution of patients by Nidra in both Groups. 11915 showing the distribution of patients by Deha prakriti in both Groups. 12016 showing the distribution of patients by Satmya. 12117 Showing the presence of RA factor in both groups 12218 Showing the presence of ASLO titer in both groups 12319 Showing the presence of CRP titer in both groups 12420 Showing the types of Amavata in both groups 12521 Showing the distribution of patients by Mode of onset in both Groups. 12622 showing distribution of patients by Nidana 12723 showing the distribution of symptoms of Amavata in both Groups. 12924 Showing the over all effect of treatment in both Groups. 130List of flow chart1] Flow chart showing Samprapti of Amavata 522] Flow chart showing pathogenesis of RA 76
  13. 13. IntroductionIntroduction Ayurveda, the fountain head of Indian medicine was conceived as ascience and preached in this country some thousands of years ago, long before theother countries could dream of systematizing the concept of the remedies forhuman ailments. With the march of time, most of the dietary habits, social structure, lifestyle, and environment have been changing. Occurrence of Amavata on largescale is one of the outcomes of this modification. It is commonest among chronicinflammatory joint diseases in which joints become swollen, painful, and stiff. Itis a debilitating disease in view of its chronicity and complications. Therefore, ithas taken the foremost place among the joint disorders. It continues to posechallenge to physician due to severe morbidity and crippling nature and claimingthe maximum loss of human power making it a biggest world wide burningproblem irrespective of races. It is equated with Rheumatoid Arthritis, aninflammatory Auto-immune disorder. The lives of more than one million people are physically impaired due toRheumatic disorders and one fifth of these are severely disabled. The onset ismore frequent during 4th and 5th decade of life with 80% of patients developingthe disease between the ages of 35 to 50 years. Women are affectedapproximately 3 times more often than men. Pregnancy is often associated withremission of the disease in the last trimester with subsequent relapses afterdelivery. About 10% of the patient will have an affected first degree relative. Agenetic susceptibility to altered immune responses probably is important in R.A. Amavata was first described as an independent disease in MadhavaNidana. It is a disease of Madhyama Roga Marga as it affects Sandhis andHridaya Marma. Though Ama and Vata are the predominant pathogenic factors A Comparative Study of Virechana karma and Basti karma in Amavata 1 W.S.R.T. Rheumatoid Arthritis
  14. 14. Introductionbut the disease represents Tridoshic vitiation. The affliction of Sandhis by Vatadosha in association with Ama, reflects the equal role of both Dosha and Dushyain the causation of this disease. Moreover, the chief pathogenic factors, beingcontradictory in nature posses difficulty in planning the line of treatment. No doubt allopathic system of medicine has got an important role to playin overcoming agony of pain, restricted movement and disability caused by thearticular diseases. Simultaneously prolonged use of allopathic medicines are notonly giving rise to many side effects, toxic symptoms and adverse reactions butalso more serious complications like organic lesions etc. are caused by them. Hence the management of this disease is merely insufficient in othersystems of medicine and patients are continuously looking with a hope towardsAyurveda to overcome this challenge.Till now 160 Ph.D and P.G. works havebeen carried out at various Ayurvedic Institutions and about 25 Reseach workshave been carried out in P.G. Institutes. This large number itself suggests its largeoccurrence and faith of patients in Ayurvedic Management. For the present study, on Amavata as Shamana therapy Nittyvirechanawith Eranda Taila and Yogabasti with Erandamooladi kwatha niruha andBruhatsandhavadi taila anuvasana has been chosen, for the comparative effect ofboth. Many works with Virechana Karma and Ksharabasti on Amavata have beensuccessfully carried out. But evaluate the comparitive effect of the results ofNittyavirechana and Yogabasti was conducted in this study. Both the therapieschosen fulfill the regimen of specific treatment of Amavata mentioned inChakradatta. Total 30 patients of Amavata were treated. These patients were randomlydistributed into 2 groups which are 15 patients reciveing Nittyavirechana withEranda taila and another 15 patients recived Yogabasti with Erandamooladi A Comparative Study of Virechana karma and Basti karma in Amavata 2 W.S.R.T. Rheumatoid Arthritis
  15. 15. Introductionkwatha niruha and Bruhatsandhavadi taila anuvasana Out of the above saidgroups Yogabasti with Erandamooladi kwatha niruha and Bruhatsandhavadi tailaanuvasana provided significantly better improvement in Rogi bala, Agni bala,Deha bala and Chetasa bala than the other group. The complete study has been made into two major divisions - theconceptual study & the clinical study. The conceptual study is grouped into aliterary review of Virechana, Basti Amavata and drug review, the clinical studycontains the Observations, Results, Discussion and Conclusion and lastlyBibliography.Need for the study: The Panchakarma therapy is an integral part of Ayurveda many diseasesaccording to Ayurveda are direct result of Srotavarodha particularly due to theAgnimandya and Ama1. Panchakarma play a vital role in Ayurvedic therapeutics. Shodhana strikes at the root of malas and eradicates them2 and as such the disorders treated with Samshodhana do not reoccur while those treated with other methods might reappear.3 Many of the chronic progressive disease like Rheumatoid Arthritis (RA) do not have an effective line of management, recent studies on RA have suggested positive results with Panchakarma. RA is an immuno inflammatory disease that affects joints and extra articular tissues4. RA occurs throughout the world and in all ethnic groups 5. The prevalence is highest in Indians. In caucasians it is around 1.0 to 1.5% with a female : male ratio 3:16. The onset of RA may occur any time in life. Approximately 70% of RA occurs between the 3rd and 7th decades7. . The disease draws attention for the consideration of research firstly due to the gravity of the problem, secondly due to the lack of suitable known A Comparative Study of Virechana karma and Basti karma in Amavata 3 W.S.R.T. Rheumatoid Arthritis
  16. 16. Introduction modern drugs for treatment and lastly it is an intriguing disease and challenge to clinicians and research workers. In the management of Amavata Ayurveda gives importance to Shodhanakarma among Shodhana Virechana and Bastikarma have got vital role8 in curingand preventing the disease. The present study intends to give new light on the comparative effect ofVirechana and Basti in Amavata so “A comparative study of Virechana karmaand Basti karma in Amavata with special reference to Rheumatoid Arthritis” isunder taken. A Comparative Study of Virechana karma and Basti karma in Amavata 4 W.S.R.T. Rheumatoid Arthritis
  17. 17. Objectives ObjectivesThe above study was carried out with following Aims and Objects: 1. To study the effect of Nittyavirechana with Eranda taila in Amavata. 2. To evaluate the efficacy of Yogabasti with Erandamooladi kwatha niruha and Bruhatsandhavadi taila anuvasana in Amavata. 3. To compare the efficacy of above two procuder in Amavata. A Comparative Study of Virechana karma and Basti karma in Amavata 5 W.S.R.T. Rheumatoid Arthritis
  18. 18. Historical reviewHistorical review of Virechana Ayurveda has propagated treatment for most of the disease, in thattreatment mainly we find two types according to Kayachikitsa Siddhanta, andthose are Shamana and Shodhana. Shamana means mitigating doshas in the bodywhen they have aggravated, though after mitigating once again they may reoccur,where as Shodhana procedure is nothing but eliminating the doshas out of thebody. In this there is no chance of reoccur. Virechana is such a treatment modality, which eliminates doshas fromGuda marga. This Virechana have well explained in Samhita kala and Sangrahakala.Samhita kala1] Charaka samhita; Explanation of Virechana dravya sangraha, Virechana yogas, itsprosuder,9,10,11 different types of Virechana dravya kalpa in Kalpa sthana,12 inSiddhi sthana we find fine explanation of Virechana Samyag laxana, Ayogalaxana, Atiyoga laxana, Virechana yogya, Ayogya, Virechana Vyapat and itsChikitsa have delt.13,14,152] Susruta samhita: In Susruta samhita Chikitsa sthana the complete procedure of Virechana,its definition, Samyag laxana, Ayoga laxana, Atiyoga laxana, Virechana yogya,Ayogya, Virechana Vyapat and its Patikara have completely explained.16,17 Insutra sthana different virechana dravyas and its preparation is explained.18,193] Astanga sangraha: In the astang sangraha sutra sthana 27th chapter whole Virechana karmahave explained,20 in kalpa sthana Virechana yogas and Vyapats are discussed.21 A Comparative Study of Virechana karma and Basti karma in Amavata 6 W.S.R.T. Rheumatoid Arthritis
  19. 19. Historical review4] Astang hridaya: In the 18th chapter of his Sutra sthana complete Virechana procedure,22 inhis Kalpa sthana Virechana yogas and Vyapats are mentioned.23,245] Sangraha kala: We find well contribution of Virechana in Sharangadhara samhita,25Kasyapa samhita Siddhi sthana,26 Bhavaprakasha poorva khanda,27 YogaratnakaraVirechanadhikara28 and Chakradatta Virechanadhikara.29Historical review of vasti In the literature it is necessary to know the past events of concerenedsubject. From ancient period it self-science of Ayurveda have started. So it isnecessary to know about the systemic documents of Veda, Purana, Yogicliterature and our Ayurvedic text.1] Veda kala Direct reference of Vasti karma will not be found in Veda, butexplanation of Vasti is their as “Vishitam te Vastibilam”302] Purana kala Vasti is indicated as the principal remedy in the probleme of increase ofVatadosha in Agnipurana.31 Different Snehas have told to use for Vastiaccourding to season.323] Yogic literature Gheranda samhita includes Vasti in Satkarma, mainly two types ofVasti have explained on their besis of administration ie first is Jala vasti whichwill be done in water, second one is Sushkavasti which is done on land.4] Samhita kala Most of the Ayuevedic classical text have given much importance to Vastikarma, that’s why we found separate Adhyayas for explaining Vasti karma and A Comparative Study of Virechana karma and Basti karma in Amavata 7 W.S.R.T. Rheumatoid Arthritis
  20. 20. Historical reviewwhile dealing the treatment of each disease we will find the elaborate version ofVasti Dravya and preparation. Vasti revieve of Samhita can be studied by referring Charaka samhita,Susruta samhita, Astanga sangraha and Astanga hridaya.Charaka samhita Charaka has explained definition of Vasti, Types of Vasti, priparetion ofVasti, Procuder of Vasti, Karmukata of Vasti, Vasti Vyapat its Chikitsa, Vastidravyas etc.33Susruta samhita Susruta widely explained definition of Vasti, Types of Vasti, priparetionof Vasti, Procuder of Vasti, Karmukata of Vasti, Vasti Vyapat its Chikitsa, Vastidravyas etc in his Chikitsa sthana.34Vagbhata Both in Astanga sangraha35 and Hridaya36 elobarate discription of Vastihave told in Sutra sthana and regarding Vasti Dravya we will find in Kalpasthana.37,38Kashyapa Samhita: In Kashyapa Samhita, Basti has been explained in detail in Siddhisthanaand Kalpasthana.39Bhela Samhita: In Bhela Samhita, description of Basti is available in four chapters ofSiddhisthana namely Bastimatriya Siddhi, Upakalpa Siddhi, Phalamatra Siddhiand Dosha Vyapadika Basti Siddhi.40Harita Samhita: In this text, only 3rd chapter of Sutrasthana deals with Basti.41 A Comparative Study of Virechana karma and Basti karma in Amavata 8 W.S.R.T. Rheumatoid Arthritis
  21. 21. Historical reviewChakradatta: In this text, two chapters named Anuvasanadhikara and Niruhadhikara aredealt with Anuvasana and Niruha Basti respectively.42Vangasena: In Chikitsa Sarasangraha, Vangasena has devoted “Basti Karmadhikara”chapter for description of Basti.Sharangadhara Samhita: Three chapters of Uttarakhanda namely Basti Kalpana Vidhi, NiruhaBasti Kalpana Vidhi and Uttara Basti Kalpana Vidhi described various aspects ofAnuvasana Basti, Niruha Basti and Uttara Basti respectively.43, 44,45Bhavaprakasha: In this Grantha, 5th chapter of Purvakhanda has been contributed to thedescription of Basti. Vrana Basti – this type of Basti has been explained in thisGrantha.46Kalyanakaraka: 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 intobeautifully woven treatises, incorporating newer diseases and their treatment,which cropped up during their times. It is evident in the Samhitas that the mostprevalent and deadly diseases have been devoted separate chapters were includedas secondary diseases under the major category. A Comparative Study of Virechana karma and Basti karma in Amavata 9 W.S.R.T. Rheumatoid Arthritis
  22. 22. Historical review Amavata might not have been widely prevalent and severely crippling as itwas during the time of Madhava Nidana, as we see only passing references to thedisease have been made in the Bruhatrayees. Madhava was the first person todevote separate chapter for Amavata. Thus the birth of this disease and itsformative years can be glanced, starting from Vedic period.Vedic period (5000 BC to 1000 BC): Clear cut explanations of Amavata are not available in Vedic Samhitas,but disease caused by Kapha have been more or less described under the majorheading Balasa, but the diseases of joints are not included here. Sayana hasquoted few references indicating arthritic syndromes, such as- Rapasi47: Disease arising due to sin (Rigveda) characterized by pain inmultiple joints also referred to as Papa. Yakshma and treatment with Jala, VayuYava, Kushta have been indicated. Jayanya48: This disease is said to affect the bones cervical vertebrae andarise from women through Sanga. Whether the disease refers to rheumatoidarthritis is still not clear. Grahi49 (Rigveda and Atharvaveda): This has been described as thedisease of joints but characteristic features have not been clearly mentioned.Treatment of this disease with Dashavruksha has been mentioned. Vatikrut50: This disease has been described as a serious ailment caused byVata and treatment with Pippali and Vishanashaka has been mentioned. Sandhivikruti51 (Atharvaveda): This disorder is caused by Sleshma andcan be treated with prayers.Samhita period (1000 BC TO 600 AD): Charaka Samhita: Charaka has described in detail Ama and AmaPradoshaja Vikara and their treatment with Langhana and Ullekhana.52 A Comparative Study of Virechana karma and Basti karma in Amavata 10 W.S.R.T. Rheumatoid Arthritis
  23. 23. Historical review Charaka had described treatment for Amavata while dealing with Avarana 53Chikitsa in Vatavyadhi, which indicate Pramehahara and Medohara Vidhi.Amavata finds a mention in the list of therapeutic indication of Kamsa Hareetaki54in Shwayathu Chikitsa and Vishaladi Phanda in Pandu Chikitsa.55 The treatment of Shariragata Ama in Grahani Chikitsa by Charaka56 issimilar to the description of Amavata Chikitsa by Bhava Mishra i.e. Langhana,Pachana and oral administration of Panchakola Phanta57, same is the case withAmavata Chikitsa of Chakrapani in Chakradatta58.Sushruta Samhita: The description of Amavata in Sushruta Samhita isconspicuous by its 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 HaritaSamhita59. The classification of Amavata is quite unique and not followed by anyof the later works in this field.Anjana Nidana: This work is claimed to be written by Acharya Agnivesha,contains detailed description about etiology, premonitory symptoms, clinicalmanifestations and complications.Sangraha Kala (600AD-1600AD): Astanga Sangraha and Astanga Hridaya have ignored the disease thoughthe word Amavata is included in the therapeutic index of compounds VatsakadiYoga60 and Vyoshadi yoga61.Madhava Nidana62: Madhavakara stated this disease as a separate entity and hasdealt separate chapter.Chakradutta: Chakrapanidutta has described the treatment for Amavata63. A Comparative Study of Virechana karma and Basti karma in Amavata 11 W.S.R.T. Rheumatoid Arthritis
  24. 24. Historical review Vangasena64 and Vrinda Madhava followed Madhava with few additionsin the treatment aspect. Works like Bhava Prakasha65, Yogaratnakara66 andBhaishajya Ratnavali67 have only corroborated the descriptions with additionalprinciples of treatment.Adhunika Kala (1600AD onwards): Mahopadhyaya Acharya Gananath Sen has coined the term Rasavata forAmavata. In Yoga Shastra the practice of Shushka Basti for improving Jatharagniand treating Amavata has been mentioned68. Y.N.Upadhyaya (1955) has corelatedthe disease with rheumatoid arthritis. Later research workers have agreed withY.N.Upadhyaya.Modern History of Rheumatoid Arthritis69 First Century AD: The rheumatoid/rheumatology is derived from the root‘Rheuma’, which refers to a substance that flows and probably was derived fromphlegm, an ancient primary humor, which was believed to originate from brainand flow to various 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 systemicdisorder.1800 A.D.: Landre Baervier a physician from Salta Petruver in Paris seemed tohave described the disease for the first time he called it Gartte AsthaniquePrimitivae.1857 A.D.: Sir Garrod proposed the name Rheumatoid Arthritis, Bannatyne alsoin 1959 published his pathological observations on the disease but he coulddifferentiate it from Osteoarthritis only in his later edition. A Comparative Study of Virechana karma and Basti karma in Amavata 12 W.S.R.T. Rheumatoid Arthritis
  25. 25. Historical review1928 A.D.: The American committee for the control of rheumatism is establishedin U.S. by Dr.R.Pemberton, renamed American Association for the study andcontrol of rheumatic disease (1934), then American Rheumatism Association(1937) and finally American 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 RA.1958 A.D.: American Rheumatic Association suggested uniform criteria fordiagnosis.1987 A.D.: The criteria were revised. In the beginning it was thought to be an infective condition especially inearly 20th century. French scientists thought it to be due to tuberculosis. Hench and Kendell introduced steroids in the management of rheumatoidarthritis described paediatric onset, juvenile RA in 1896. Later Felty A.R.described Felty’s syndrome. Recent advancement in immunology has opened new vistas in themanagement of RA. Unfortunately till date the etiology of RA is unknown thepathogenesis is speculative, the treatment is only palliative and there is no cure tothis disease. A Comparative Study of Virechana karma and Basti karma in Amavata 13 W.S.R.T. Rheumatoid Arthritis
  26. 26. Virechana karmaRevive of virechana karma Virechana is one of the Shodhana karma described by Acharyas. It is aspecific process for elimination of Pitta Dosha, but other two Dosha to someextent. It is less tedious procedure than Vamana and hence less possibility ofcomplications, and could be done easily. So Virechana karma is widely practicedShodhana therapy in routine.Definition: The process of elimination of Dosha from Adhomarga is known asVirechana 70. Sometimes actions of expelling Doshas through both Urdhva (Vamana) andAdhomarga are also termed commonly as Virechana. For instance Caraka hasmentioned Yoga of Vamana and Virechana both. Even for Niruha Basti andShodhana Nasya Virechana term is used. But in this context Virechana can beunderstood as a procedure-involving intake of medicine through oral route andexpelling vitiated Pitta Dosha and Mala through Adhomarga71.Pharmacodynamics of Virechana Karma: The Bhuta predominance as well as the properties of drug should beanalyzed in detail to explain the Pharmacodynamics of the particular drug inVirechana Karma. Contrary to Vamana Dravya, Virechana Dravya possessessome properties, which are not in accordance with the Bhautik constitution72.Table-1, Bhoutik composition of virechana dravyaBhautik Composition Properties expected Properties present Sneha Ushna Bhumi Manda Tikshna Jala Sthula Sukshma Guru Vyavayi Virechana Dravya has Guna, which are not in accordance with Bhutas,which may be explained in terms of Vichitra Pratyayarabdhata. This Vichitra A Comparative Study of Virechana karma and Basti karma in Amavata 14 W.S.R.T. Rheumatoid Arthritis
  27. 27. Virechana karmaPratyayarabdhata causes bivalent action of the drug an action in the Shakhas,which is entirely opposite to the Koshta. The drugs with properties like Ushna, Tikshna, Vyavayi and Sukshma byvirtue of their penetrative as well as infiltrative properties enter Hridaya and fromthere they spread through Dhamanis. These drugs cleanse the adhesive bodyHumours by their Agneya Guna and thoroughly disintegrate them by TikshnaGuna. This brings the Doshas to Amasaya. Proper Snehana and Svedana havedone previously facilitate this process. The circulating metabolic abnormal orwaste products are thus treated by this process and actively excreted to theintestinal lumen. In the Koshta contrary to the Vamana Dravya, further actiontakes place according to the Bhuta predominance and Adhobhaga Prabhava of thedrugs. This bivalent property makes the Virechana drug practically lesscomplicated and easily employable. Moreover this is the only reason for theelimination of Dosha through Virechana from Kaphasthana (Amashaya),Pittasthana (Pachyamanashaya) and Vatasthana (Pakvashaya). But the action ofVamana is focused in Amashaya only.Indications and contraindications of virechana karma: Prior to subjecting the patient to any therapy, it is necessary to examinewhether the patient is fit for proposed therapy or not. Following are theindications and contra indications for Virechana karma.Indication:1. DoshaUtklishta Pitta, Kapha Samsrshta Pitta, Pittasthanagata Alpa Kapha,Kaphasthanagata Bahu Pitta73.Pakvashayagata Pitta or Kapha Pitta74.Pitta Avrata Vata, Kapha Avrta Vata75. A Comparative Study of Virechana karma and Basti karma in Amavata 15 W.S.R.T. Rheumatoid Arthritis
  28. 28. Virechana karma Caraka advises that Tiryakgata Dosha should be taken back to Koshta,gradually by proper acts and after that elimination should be carried out. Thisdenotes that Virechana is the treatment of choice in Tiryakgata Dosha as seen inKushta.2. Dushya For Rasa, Rakta etc, Vikaras Virechana Karma is described in direct orindirect way76, 77,78.3. In Svastha794. Purvakarma of Rasayana and Vajikarana 80.5. Virechana is indicated in disorders like, Gulma – Vatadhikya, Kamala –Paittika, Gara – Tridoshaja, Unmada –Tridoshaja, Kushta – Tridoshaja etc.From the above references it becomes clear that Virechana karma has a specificaction on various conditions of all three Doshas. It is a procedure of choice forhealthy as well as diseased person.Contraindication: In Classics, Contra indications of Virechana are explained in detail. Theycan be summarized in following headingsIncapable to tolerate the stress of therapy like Vilanghita, Durbala, Subhaga,Navaprasuta etc Sama Avastha of the disorders like Navapratisyaya, Ajirna, NavajvaraDiseases of rectum like Kshata Guda, Muktanala.Some conditions like Ratri Jagarita, Atisnigdha, Atiruksha, Bhayoptapta,Chintaprasakta.Disorders like Adhoga Raktapitta, Hradroga, Atisara, Rajayakshma, Urusthambhaetc81, 82,83. A Comparative Study of Virechana karma and Basti karma in Amavata 16 W.S.R.T. Rheumatoid Arthritis
  29. 29. Virechana karmaTypes of virechanaI. According to Mechanism of Action: Virechana Dravya is several in numbers. According to Caraka, there are 3types of Virechana Dravya Viz, Trivrt, Aragvadha and SnuhiKshira areconsidered as the best Sukha Virechana, Mrdu Virechana and Tikshna Virechanarespectively84. Acharya Caraka also described Bhedaniya, Virechanopaga andAnulomana, which are also suggestive of the types of Virechana. ButSharangadhara has given a specific description regarding the types ofAdhobhagahara karma; they are Anulomana, Sramsana, Bhedana and Rechana85.II. According to Prayoga Bheda: Curna, Vati, Asava, Arista, Avaleha, Sneha and Kashaya etc, Virechanayoga can be administered in this form of preparation.III. Based on Part of the Dravya used: Sushruta describes the following drugs with priority for VirechanaKarma86.Mula Virechana Syama TrivrtPhala Virechana HaritakiTaila Virechana ErandaSvarasa Virechana KaravellakaPaya Virechana Snuhi.Caraka also describes in general Virechana drugs like Mulini, Phalini, Lavana andKshira etc.iv. Classification according to quality: Caraka and Sushruta have used the terms like Snigdha Virechana andRuksha Virechana. A Comparative Study of Virechana karma and Basti karma in Amavata 17 W.S.R.T. Rheumatoid Arthritis
  30. 30. Virechana karmaProcedure of virechana For easy understanding purpose whole Virechana procedure can begrouped under headings like I. Purva Karma II. Pradhana Karma and III. PascatKarmaI.Purvakarma: Purvakarma includes,Sambhara Samgraha- Collection of all the necessary equipments, drugs, diet etcused for the therapy.Atura Pariksha- The detail examination of the Dosha, Dooshya, Atura Bala etc tobe carried out to know fitness of individual to Shodhana87.Atura Siddhata- Snehana and Svedana are to be carried out prior to VirechanaKarma88. After observing Samyak Snigdha Lakshana by Snehapana, 3 daysVishrama Kala is given prior to Virechana. During those days SarvangaAbhyanga and Bashpa Sveda are performed.Diet- Snigdha, Ushna, Drava, Mamsarasa, Yusha, Amla Rasa Ahara is preferableduring Vishrama Dina. But Kapha Vardhaka Ahara is to be strictly avoided89.Manasopacara- Whole procedure of Virechana is to be explained to boostconfidence of the individual.Matra Vinischaya- Matra should be selected in such a way that the desired effectof Shodhana may be achieved without any complications. The dose is to bedecided based on Atura, Agni, Koshta and Aushadha.While describing the process of Virechana the dose mentioned of Trivrta yoga isone Aksha (1 tola).However Sharangdhara has given the dose schedule, which seems to be applicablenow a day. A Comparative Study of Virechana karma and Basti karma in Amavata 18 W.S.R.T. Rheumatoid Arthritis
  31. 31. Virechana karmaTable-2, Doses of Virechana drugs according to Sharangdhara 90,91Kalpana Hina Matra Madhyama Matra Uttama MatraKvatha ½ Pala (2 tola) 1 Pala ( 4 tola) 2 Pala (8 tola)Curna 1 tola 2 tola 4 tolaKalka etc.Table-3, Matra according KoshtaAuthors Mrdu Koshta Madhyama Koshta Krura KoshtaSushruta92 Mrdu Matra Madhyama Matra Tikshna MatraVangasena 1 tola 2 tola 3 tolaiii) According to Vagbhata, persons having less strength, Shodhita previously,having less quantity of Dosha, having thin structure and unknown Koshta shouldbe administered Mrdu Aushadha with very less quantity93.II Pradhana Karma:Pradhana Karma includes,Administration of Virechana YogaObservation and management during Virechana VegaObservation of-Shuddhi Lakshana-Virechana Vyapat if anyAdministration of Virechana yoga: Caraka has explained method of Virechana elaborately in Charaka94 as, aftercompletion of Snehana and Svedana, by finding that the individual is cheerful,slept well, and fully digested his meal, is advised to perform auspicious rites.Thereafter considering the Vaya, Bala, Dosha, Bheshaja etc, and after passing thetime of Kapha Prakopa in morning the individual should be given VirechanaYoga in empty stomach. A Comparative Study of Virechana karma and Basti karma in Amavata 19 W.S.R.T. Rheumatoid Arthritis
  32. 32. Virechana karma After administration of the drug, cold water is sprinkled on the face toavoid vomiting and then the individual is asked to gargle with hot water and tohave fragrance of flower etc. He should be protected from direct cold wind andshould take rest in the bed. He is advised to not to retain the Vega as well asdon’t make Pravahana95.2. Observation and management during Virechana Vega:During all the time, Vaidya should concentrate on the manifestation of Lakshanaof Jirna-Ajirna Aushadha, Shuddhi and Vyapat etc.3. Observation of Shuddhi Lakshana:Virechana Shuddhi can be assessed as shown in the Table-4, based on parameterslike Vaigiki, Maniki, Antiki and Laingiki Lakshana.Table-4, Assessment parameters of VirechanaShuddhi Hina Madhyama PravaraVaigiki 10 Vega 20 Vega 30 VegaManiki 2 Prastha 3 Prastha 4 PrasthaAntiki Kaphanta Kaphanta KaphantaLaingiki Lakshana As per described in Table-5Manifestation of Samyak yoga, Atiyoga, Ayoga Lakshana and Vyapat should beobserved as per texts 96,97,98,99,100,101 Samyak Yoga Lakshana: Among different Laingiki Lakshana documented in the classics some aremanifested on the day of Virechana and others on later days. In comparison toother Shuddhi Lakshana the Laingiki Lakshana is given much importance 102. A Comparative Study of Virechana karma and Basti karma in Amavata 20 W.S.R.T. Rheumatoid Arthritis
  33. 33. Virechana karmaTable-5Samyak Yoga Lakshana of VirechanaLakshana Caraka Sushruta VagbhataSrotovishuddhi + - -Indriya Prasada + + -Buddhindriya and Manas Shuddhi + - -Laghuta + + -Agnivriddhi + - -Anamayatva + +Vit-Pitta-Kapha-Vata Kramena Prapti + + -Vatanulomana - +Absence of Ayoga Lakshana - - +Manahprasada - + -Dourbalya + - -Glani + - -Aruci + - -Hrdaya-Varna Vishuddhi + - -Kshudha – Trshna + - -Vegapravartanam in Proper time + - -Virechana Vyapat: The complications arising due to improper Virechana Karma are known asVirechana Vyapat. Ayoga and Atiyoga of Virechana may lead to manifestation ofVyapat 103,104,105Opinions of Acharyas regarding Virechana Vyapat are shown in Table-6Table-6, Virechana VyapatVyapat Caraka Sushruta VagbhataAdhmana + + +Parikartika + + +Parisrava + + +Hrdgraha + - +Gatragraha + - SarvangagrahaJivadana + + +Vibhramsha + - Guda VibhramshaStambha + - - A Comparative Study of Virechana karma and Basti karma in Amavata 21 W.S.R.T. Rheumatoid Arthritis
  34. 34. Virechana karmaKlama + - -Upadrava + - -Vamana - + +Savashesha Aushadhitva - + +Jirna Aushadhitva - + +Hina Aushadhitva - + -Vata Shula - + VedanaAyoga - + +Atiyoga - + +Hridaya-Upasarana - + -Vibandha - + -Pravahika - + +Visamjnata - - +III. Paschat Karma: Following points can be considered under Paschat KarmaTat Kalina Paschat Karma: After the stoppage of Virechana Vega, the hands, feet and face of the individualshould be well washed and he should be consoled for sometime and instructed tofollow Pathya as explained in the context of Snehana and Virechana 106.Kalantarina Paschat Karma:Individual is instructed to follow appropriate Samsarjana Krama’s as per the • Shuddhi Lakshana • Peyadi Samsarjana • Tarpandi Samsarjana. Samsarjana Krama is a specific dietary regimen, which is to be followedafter Shodhana Karma. The aim of this Krama is to increase Agni Bala gradually,which has become weak due to Shodhana. Caraka reveals importance by givingexample that small sources of fire, if simulated by adding small and light fuel, A Comparative Study of Virechana karma and Basti karma in Amavata 22 W.S.R.T. Rheumatoid Arthritis
  35. 35. Virechana karmalater on become so big that it can burn anything. Similarly by applyingSamsarjana Krama Jatharagni can be increased to such an extent that it can digestall types of food 107. Caraka has mentioned that Peya, Vilepi, Akrita yusha and Krita yushashould be administered for the period of 3, 2, and 1 meal times to the patienthaving Pravara, Madhyama and Avara type of Shuddhi respectively 108. Sushruta has described Yusha of Kulattha, Adhaki, Mudga and MamsaRasa for this purpose. Dalhana advises that the Peya should be given in theconditions of Kshina Kapha, but when Vata is dominant Mamsa Rasa should berecommended 109. When proper Virechana doesn’t occur at that time instead of PeyadiKrama, Tarpana is indicated. It is also recommended that the persons addicted toalcohol, having Vata Pitta Prakrti and if Kapha and Pitta are dominant even afterVirechana Karma, Cakrapani mentioned that in the place of Peya and Vilepi,Svaccha and Ghana Tarpana should be given respectively 110.Importance of Virechana Vamana and Virechana are the main principal remedies in cleaning thesystem of all the doshas from the body. On this Dalhana opines, PakwashayagataVata, Pitta and Kapha will be eliminated by 1, 2, 3 Vastis, Dhuma, Nasya, Kavalaetc also eliminate the doshas little by little. Where as Vamana and Virechana willeliminate the doshas completely out of the body.111, 112Different varities of virechana If we gone through our ayurvedic texts mainly we found three types ofVirechana, wheather it may be Anulomana, Srousana, Bhedhana or Rechana,those three types are A Comparative Study of Virechana karma and Basti karma in Amavata 23 W.S.R.T. Rheumatoid Arthritis
  36. 36. Virechana karma1] Virechana, which is done after Snehana and Swedana followed by Samsarjanakarma.2] Sadhyovirechana, which is given in the emergency condition, with out Snehanaand Swedana like Vamanavyapata, Kosthabadhata or for the shake ofKoshasuddhi.3] Nittyavirechana which is giving daily for long time with out consideringSnehana and Swedana followed by Samsarjana karma with consideration ofKostha and Bala of patient, it may be continued for 8 days or 15 days or 1 monthand so on.1] Virechana This type of Virechana has already explained in the previous pages.2] Sadhyovirechana Sadhyovirechana contains two words, one is Sadhyo and another isVirechana, Sadhyo means at that movement or immediate. Virechana meanseliminating doshas from Guda marga by takeing Aoushadha with Mukhamarga.So totally Sadhyovirechana means instant elimination of doshas with Gudamargaby taking Aoushadha through Mukhamarga with or without considering Snehanaand SwedanaScope of Sadhyovirechana1] Second stage of Vishavega2] Urdhvaga raktapitta3] Amavata4] Vamana Ayoga and Atiyoga5] Vibhanda6] Alasaka A Comparative Study of Virechana karma and Basti karma in Amavata 24 W.S.R.T. Rheumatoid Arthritis
  37. 37. Virechana karma7] In weak person if there is a Bahudoshas and if dosha paka have attaineddirectly Bhedhaniya Aoushadha or Bhedhaniya Ahara dravya can be advised.Like this still in many conditions we will find in our classics.113 Sadhyovirechana does the effect of eliminating Vishapadhartha andaccumulated fecous thus does Vatanulomana. Due to administering Sadhyovirechana with or without consideringSnehana and Swedana using of Snehika virechana is beneficial, this holds goodbecause of in Ruksha person Snigdha virechana have advised.114, 115 Other wisegiving Ruksha virechana to a person who has not under gone for Snehapana willdestroy like dry stick when bends it. We get strong reference of using Sahdyovirechana with Eranda tailcombining with Triphala kwatha in Chakradatta116 Yogaratnakara117 andSharangdhara118 uttara khanda. Even for the test of Krura kostha, Madhyama kostha and Sadharana kosthathis type of Sahdyovirechana helps. In Kruradikostha giving Eranda tail as a Sahdyovirechana is the choice ofdrug. Even instead of Eranda tail Ksheera can also be used in that condition.1193] Nittyavirechana The literary meaning of Nittyavirechana includes two words, one is Nittyaand another is Virechana. Nittya means everyday or consecutive days for two ormore than two days, Virechana means eliminating doshas from Guda marga bytakeing Aoushadha with Mukhamarga. So Nittyavirechana gives the meaning asadministering virechana Aoushadha everyday or consecutive days for two or morethan two days. A Comparative Study of Virechana karma and Basti karma in Amavata 25 W.S.R.T. Rheumatoid Arthritis
  38. 38. Virechana karmaParyayanama of Nittyavirechana 1] Nittya shodhana 2] Nittya anulomana 3] NittyavirechanaScope of Nittyavirechana A debilitated person who has under gone Shodhana therapy earlier and aperson who has very little quantity of doshas inside the body but he is emaciatedand he whose nature of Kostha is not known should be given mild drugs in smalldoses, better still in repeated doses, other wise it will create doubt of fatalcondition. If in a debilitated person the doshas are found to be in motion [Chalandoshana] and in large quantity they should be removed out of the body little bylittle using mild drugs and if they are in little quantity they should be mitigated byShamana therapy. Other wise if they remain in side the body for long time causestrouble to the body and might even kill the person if they are not expelled out ofthe body. 120,121,122 Dalhana opines Chalana doshan as Kupitan doshan, Indu commentator ofAsthangha sangraha opines on Chalana doshan, as doshas are in Prabhuta matradoshas should be eliminated with Mrudu Virechana dravya. Arunadatta commentson above version, as taking Virechana Aoushadha everyday day is Shrestha orVaram. Before giving Shodhana Karma we should win over Kapha and Vata in theMandagni and Krurakostha than only Virechana aoushadha can be given.123, 124,125 Even Bhoja also opinions that if doshas are less aggravated they should bemitigated by Shamana chikitsa, if the Bahudosha condition is their, they should beeliminated little by little with out harming the patient. A Comparative Study of Virechana karma and Basti karma in Amavata 26 W.S.R.T. Rheumatoid Arthritis
  39. 39. Virechana karma Doshas, which are mitigated by Shamana chikitsa, are likely to reappearagain but those, which are expelled out of the body by Shodhana Karma i.e. byVamana and Virechana, do not re-occur. This statement does not holds good insome conditions like Udararoga, Amavata, etc because in these diseases everydaythe re-accumulation of doshas will takes place that’s why in these type ofcondition Nittyavirechana helps in eliminating the doshas which accumulatedaily. In above told condition Mrudu type of Nittyavirechana helps. Mrudumeans we can use Draksha, Paya, Ushnambu or Tail, Commenting on TailAdamalla opines to consider Eranda tail. While explaining Abhayadimodaka it is well explained that when takingNittyavirechana in little quantity there is no any restriction of food or otheractivities or in this condition Tarpanadi karma can be followed other wiseShastika shali anna with Yavagu of Mudga and other grams or Jangala mamsarasawith Shastika shali anna is benifisial.126Benefits if Nittyavirechana1] Helps to eliminate doshas which accumulate everyday.2] Act as Rasayana if they are taken for long time. For example Eranda tail andAbhayadimodaka. A Comparative Study of Virechana karma and Basti karma in Amavata 27 W.S.R.T. Rheumatoid Arthritis
  40. 40. Basti karmaVasti 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 Vasti.127 2. Due to giving medicine by Vasti Putaka is called Vasti.128, 129,130 3. Due to administering medicine in to Gudamarga with Vasti is called Vasti.131 4. Which is Sadhyakarma with Mootradhara Putaka is Vasti.132 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.133Vasti 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.134 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.135, 136 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 Vayu A Comparative Study of Virechana karma and Basti karma in Amavata 28 W.S.R.T. Rheumatoid Arthritis
  41. 41. Basti karmaalong with Pitta, Kapha and feces. Because of allivetion of this Vayu, all thediseases pervading the whole body get alleviated.137 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. 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.138, 139,140Importance of Basti karma Vata is the Neta141 of all Dosas, it is considered as Ishvara142 and it is the 143,144causative factor for all trimargaja rogas . For this type of Vata Vasti is thebest amoung other Karmas.This Vasti is considered as Ardha chikitsa because ofdisease produced by Vata are 80 in number.145 A Comparative Study of Virechana karma and Basti karma in Amavata 29 W.S.R.T. Rheumatoid Arthritis
  42. 42. Basti karma Vasti can be utilized in Bala, Vridha, Krasha, Sthoola, Kshina dhatuperson, and in Sthree.146 In the Snehadi karma Basti is chief, because of havingShodhana effect, Shamana effect, Sangrahana effect, Vajikarana effect, Brohanaeffect etc.147 Vasti is beneficial if it is used with different drugs in Vata, Pitta, Kapha,Samsargaja and Sannipataja disorders.148, 149 Vasti is Amruta samana in Shishu and Ashishu, 150 when Vasti is used incombination of Niruha and Anuvasana it eradicates all type of diseases.151 Main specialty of Vasti is first it do the Utkleshana of doshas thanShodhana of doshas and lastly Shamana of doshas.152, 153,154 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.155 Vasti if appropriately administered keeping in view the strength of patientdoshas involved in the causation of disease, nature of disease of disease, physicalconstitution of patient and properties of different groups of drugs prescribed fordifferent diseases cures these ailments.156 No other therapeutic measures other than Vasti cleanses the body quicklyand easily, causes depletion and nourishment instantaneously and is free from anyadverse effect.157 Vasti is useful in Pangu, Urustambhs, Bhagna etc.158 Virechana and Vamana therapy no doubt causes elimination of doshas butit involves intake of recipe ingredients of which are pungent, sharp, hot etc.Those A Comparative Study of Virechana karma and Basti karma in Amavata 30 W.S.R.T. Rheumatoid Arthritis
  43. 43. Basti karmaingredients causes’ unpleasantness eruption nausea cardiac discomfort and pain inthe gastrointestinal tract.159 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.160Basti 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 conditions A Comparative Study of Virechana karma and Basti karma in Amavata 31 W.S.R.T. Rheumatoid Arthritis
  44. 44. 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 A Comparative Study of Virechana karma and Basti karma in Amavata 32 W.S.R.T. Rheumatoid Arthritis
  45. 45. Basti karma • 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.Types of Basti Two types of basti • Niruha basti, Auvasana basti 161 • Niruha basti, Snehika basti 162 • Shita basti, Sukhoshna basti 163 Three types of basti • Asthapana basti, Auvasana basti, Uttara basti.165, 166,167 • Utkleshana basti, Shodhana basti, Shamana basti 168,169,170,171 • Karma basti, Kala basti, Yoga vasti.172, 173,174 • Vatahara basti, Pittahara basti, Kaphahara basti.175 • Sneha basti, Anuvasana basti, Matra basti.176 • Teekshna basti, Mrudu basti, Sadharana basti.177 • Kaphavatahara basti, Kaphapittahara basti, Pittaraktahara basti.178Four types of basti • Asthapana basti, Auvasana basti, Uttara basti Matra basti.179 • Pakvashayagata basti, Shiro basti, Kati basti, Vrana basti.Five types of Madhutailika basti 1] Madhutailika basti180 2] Youktaratha basti181 A Comparative Study of Virechana karma and Basti karma in Amavata 33 W.S.R.T. Rheumatoid Arthritis
  46. 46. Basti karma 3] Doshahara basti182 4] Siddha basti183 5] Mustadiyapana basti.184Six 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 185 1. Chatuprasruyika basti 2. Panchaprasruyika basti 3. Shatprasruyika basti 4. Saptaprasruyika basti 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 A Comparative Study of Virechana karma and Basti karma in Amavata 34 W.S.R.T. Rheumatoid Arthritis
  47. 47. Basti karma (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 bastiBrief 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. A Comparative Study of Virechana karma and Basti karma in Amavata 35 W.S.R.T. Rheumatoid Arthritis
  48. 48. Basti karma 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. 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 187. Depending upon drugs and preparations used in Basti it may be classified as follows: 188 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 BastiSneha 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). 189,190A Comparative Study of Virechana karma and Basti karma in Amavata 36 W.S.R.T. Rheumatoid Arthritis
  49. 49. 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 isfollowed.Rectal Administration: Substances may be introduced into the rectum for exciting evacuation orfor 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. A Comparative Study of Virechana karma and Basti karma in Amavata 37 W.S.R.T. Rheumatoid Arthritis
  50. 50. 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, who 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 smallenema 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. A Comparative Study of Virechana karma and Basti karma in Amavata 38 W.S.R.T. Rheumatoid Arthritis
  51. 51. Basti karma 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. a. 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 of 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. b. 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 A Comparative Study of Virechana karma and Basti karma in Amavata 39 W.S.R.T. Rheumatoid Arthritis
  52. 52. Basti karma 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 withthe technique of the retention enema, because they are to be retained for manyhours, 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.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 thisproperty might be of clinical value. A Comparative Study of Virechana karma and Basti karma in Amavata 40 W.S.R.T. Rheumatoid Arthritis
  53. 53. Basti karmaRules: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 tounload 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. A Comparative Study of Virechana karma and Basti karma in Amavata 41 W.S.R.T. Rheumatoid Arthritis
  54. 54. Basti karma3. 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.5. 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. A Comparative Study of Virechana karma and Basti karma in Amavata 42 W.S.R.T. Rheumatoid Arthritis
  55. 55. Basti karma3. 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 route A Comparative Study of Virechana karma and Basti karma in Amavata 43 W.S.R.T. Rheumatoid Arthritis
  56. 56. 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 dasa producing block in the body channels that stations itself in the sandhi giving rise to Amavata191. 2. The combinations of ‘Ama’ and vata form Amavata. It shows the Pridomminance of Ama & vata in the samprapti of Amavata 192. 3. Ajeerna produce ‘Ama’ & along with vata it produce Amavata193.Definition ‘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 194.Importance 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 195. 2. Ama means, “Which is subject of digestion”. 196 A Comparative Study of Virechana karma and Basti karma in Amavata 44 W.S.R.T. Rheumatoid Arthritis
  57. 57. AmavataDefinition 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 197,198. 2. The undigested Adya Ahara dhatu is Ama 199. 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’. 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 the A Comparative Study of Virechana karma and Basti karma in Amavata 45 W.S.R.T. Rheumatoid Arthritis
  58. 58. Amavataresponsible 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 derived 200from “Va gati gandhanyoh” it means to move, to make known, to enthuse . Ithas got the other synonyms like Anila, Maruta, Pavana etc.201Gunas of Vata Ruksha, Seeta, Laghu, Sukshma, Chala, Visada, Parusha & Khara 202,203.Functions 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 functions204. 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 pravartaka 9. Sabdasparsa Prakrti 10. Srota sparsana mula 11. Harsha utsahayoni 12. Agni samirana 13. Mala ksepta 14. Grabhakrti Karta 15. Ayusha Anuvratti 205. A Comparative Study of Virechana karma and Basti karma in Amavata 46 W.S.R.T. Rheumatoid Arthritis
  59. 59. Amavata 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 206. 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 207 1. Parava Samkocha 2. StambhaA Comparative Study of Virechana karma and Basti karma in Amavata 47 W.S.R.T. Rheumatoid Arthritis
  60. 60. Amavata 3. Asthi Paravabheda 4. Lomaharsa, Pralapa, Hasta-Pristha-siro-graha 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. Madhavakar 208 has 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.A Comparative Study of Virechana karma and Basti karma in Amavata 48 W.S.R.T. Rheumatoid Arthritis