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Case Presentation- Amavata
1. DR. SHAILESH
2nd YEAR PG SCHOLAR
DEPARTMENT OF PANCHAKARMA
SDMCA&H
CASE PRESENTATION
1
2. BIODATA
NAME :NAGARATHNAMMA
AGE : 46 YRS
SEX : FEMALE
RELIGION : HINDU
MARITAL STA : MARRIED
OCCUPATION : HOUSE WIFE
ADDRESS : ANANTAPAUR, A.P.
D.O.A :19-12-16
D.O.D : 29-12-16
OP NO :
IP NO :18228
2
5. H/O PRESENT ILLNESS
•As per the patient she was normal 5 year’s back.
•One day she experienced feverishness followed by multiple joint pain
• This pain subsided without medications
•After an year she noticed stiffness in the fingers.
•Later, there was pain in the low back region. 5
6. • Gradually she started complaining of pain in wrist,
elbow, shoulder, knee and ankle bilaterally.
• Severity of the pain started increasing and sometimes
associating with swelling.
• During the episodes of pain she experienced stiffness in
all major and minor joint along with lethargy.
6
7. H/O PAST ILLNESS
FAMILY HISTORY
Menorrhagia - Hysterectomy done in 2009
No relevant family history contributing to the current condition
of the patient.
All members are said to be healthy.
7
8. PERSONAL HISTORY
Appetite : Decreased
Bowel : 1time/day, Hard stools
Micturition : 4-5 times/day
Sleep : disturbed
Addiction: -
8
9. GENERAL EXAMINATION
Built Moderate
Pallor Absent
Icterus Absent
Cyanosis & Clubbing Absent
Lymphadenopathy Absent
Tongue coating ++
Pulse rate 84/min
BP 130/90 mm Hg
9
14. SYSTEMIC EXAMINATION
Respiratory system – NVBS
Cardiovascular system- NAD
Musculo skeletal system –
On inspection –
• difficulty in extension of fingers
• mild swelling in interphalangeal joints
On palpation –
• rise in temp in joints
• mild tenderness in joints
14
15. LABORATORY INVESTIGATION
HAEMATOLOGY
Hb 13.8 gm%
T.WBC 10,100
cells/cu mm
ESR 32 mm/hr
DIFFERENTIAL COUNT
Neutrophils 72(40-70%)
Lymphocytes 25(20-40%)
Monocytes 01(2-6%)
Eosinophil 02(1-4%)
Platelet 3.25 lakhs
RBC 4.86 mil/mm3
BIO CHEMISTRY
FBS
RA
100.8 mg/dl
+ ve
15
34. Day Date Procedures Observations
1 19/12/16 •Sar. Udvartana + parisheka
with DMQ + Dhanyamla
•Valuka sweda at night
•Chitrakadi vati 3 tid. b/f
•Amavatari rasa 4 tsp. tid.
•Guduchi churna + yastimadhu
churna (2:1) 1 tsp. with water
a/f
•Sandishota reduced
•Sandi shula present
•Gaurava present
•Her steroid dose was
reduced to half
2 20/12/16 Same as above
3 21/12/16 Same as above
4 22/12/16 In addition to above treatment,
•Nimbamrutadi eranda taila 3
tsp. at 6pm (empty stomach)
•Mudga yusha from pathyahara
•Sandi shula reduced
•Rest same
34
TREATMENT
35. Day Date Procedures Results
5 23/12/16 •Sar. parisheka with DMQ +
Dhanyamla
•Valuka sweda at night
•Chitrakadi vati 3 tid.
•Amavatari rasa 4 tsp. tid.
•Panchakola phanta 50ml tid. (b/f)
•Guduchi churna + yastimadhu
churna (2:1) 1 tsp. with water
In addition to above treatment,
•Nimbamrutadi eranda taila 3 tsp. at
6pm (empty stomach)
•Mudga yusha from pathyahara
Sandi shota, shula,
gaurava reduced.
6 24/12/16 In addition to the above treatment,
Matrabasti with 80 ml pippalyadi taila
7 25/12/16 Vaitarana basti was added to the
above treatment schedule
Patient stopped
taking steroids
8 26/12/16 Same as above
35
36. Day Date Procedures Results
9 27/12/16 •Sar. Abhyanga with sarshapa taila
followed by parisheka with DMQ +
Dhanyamla
•Valuka sweda at night
•Chitrakadi vati 3 tid.
•Amavatari rasa 4 tsp. tid.
•Guduchi churna + yastimadhu churna
(2:1) 1 tsp. with water
•Mudga yusha from pathyahara
•Vaitarana basti
10 28/12/16 Same as above
36
37. VAITARANA BASTI
Anuvasana Basti:- Brihat saindavadi taila- 80 ml
Niruha basti:-
Guda paka:120 ml
Chincha rasa: 5 gms
Saindhava : 12 gms
B.S.Taila:- 100 ml
Gomutra:- 200 ml
पे र्ुन्क्त कर्ण कु दव अन्लेक शसधिूजधम
गोमुि: तल्युक्तो अयम र्न्स्त र्ुे आलाह आमवत हर:
चक्रदि
1st 2nd 3rd 4th 5th 6th
A N N N N A
A A A A
37
38. DISCHARGE MEDICINES (FOR 2 MONTHS)
Guduchi churna(200gm) + shunti churna(30gm)+
bala churna(100gm) + arjuna twak churna(100gm)
+ yashtimadhu churna(10gm)
Mixture of above churna -1 tsp. with warm water
Amvatari kashaya 4tsf tid. b/f with water
Cap. Cervilon 1 bd. b/f
Kaishora guggulu 2 bd. a/f
Abhaya massage oil for L/a
38
39. RESULTS
Parameters BT AT
Shota:- +++ Nil
Shula:- +++ + (Slight pain on
motion)
Sthamba:- +++ Normal
Tenderness ++ Absent
Lab Investigation BT AT (on
follow up)
ESR 32
RA + ve
39
47. CONCLUSION
Amavata as a separate disease and its detailed
description is available in medial period text
Madhava Nidana. It can be concluded that
Mandagni is largely responsible for the formation of
Ama which chief pathogenic factor of the disease.
Amavata is the disease having Vata and Kapha
predominance. But, in fact it is Tridoshika with
origin from both Pakvashaya and Amashaya
47
If a person continuously indulge in the etiological factors as described in the context of the disease such as Viruddha Ahara, Nishchala Cheshta, or mental factors such as Kama, Krodha, Shoka, Chinta, Bhaya etc. it leads to the deviation of the Agni from the normal stage causing Mandagni. This Mandagni causes the formation of Ama. Along with this, there is vitiation of Vata due to indulgence in the Vata Prakopaka Nidana. Now this morbid Ama circulates all over the body by the vitiated Vata Dosha. This condition can be clinically termed as Samavata. Ama propelled by Vata reaches the Sleshma Sthana of the body. Here, Ama blends with all the three Doshas and consequently attains various colors and becomes heavy and viscous. The vitiated Ama facilitates Srotoabhishyandana and Srotorodha, vitiated Vata and Ama reaches the Trika and other joints causing stiffness in the whole body and thus producing disease Amavata.
Now let us see what are the samanya lakshana’s of Amavata. The disease amavata is characterised by angamar…
No sloka. Explain the sloka.. The disease amavata is corelated with ra. Now let us have a look on few facts about RA.
It is very important tat the disease am
लंघनं स्वेदनं तिक्त दीपनानि कटुनि च ।विरेचनं स्नेहपानं बस्तयः च आममारुते ॥रुक्षस्वेदो विधातव्यो वालुका पोटलैः तथा ।उपनाहश्च कर्तव्याः तेऽपि स्नेह विवर्जिताः ॥(यो.र)
उपनाहश्च कर्तव्याः तेऽपि स्नेह विवर्जिताः ॥(यो.र)
लंघनं स्वेदनं तिक्त दिपनानि कटुनि च ।विरेचनं स्नेहपानं बस्तयश्चाममारुते ॥ सैन्धवाध्येनानुवास्य क्षारबस्ति प्रशस्यते । (च.द)
avata should be handled very tactfully. The avasthanusari management of amavata is important…
Sushrutha in vatavyadhi chikitsa adhyaya have clearly stated that (tell sloka here) that is when the prakupita vata is present in pakvashaya then one should so for snehavirechana and then shodhana basti’s. while commenting on same sloka dalhana says that “ पक्वाशय: पुनरिह द्विविध: - पित्तवाताशयभेदेन, तयोर्मध्ये पित्ताशयगते वोयौ स्नेहविरेचनं तिल्वकसिद्धम् एरण्डतैलादिभिर्वा, वातशयगतस्य तु वायो: मलकफैरावृतस्य यथादोषं कषायकल्कस्नेहबस्तय:।
Very much importance have been given to eranda sneha in the treatment of amavata. Vangasena had said that eranda taila is like a gajakerasi in controling the amavata gajendra..hence many of the yoga’s have been mentioned with eranda taila in the management of amavata. The use of eranda taila in amavata suggests that in this disease snigdha and not ruksha virechana should be employed, since it does not produce generalised snehana effect but by its snigdha, ushna etc. characteristics, it augments the agni in addition to its vata anulomana action.
Last in treatment of amavata basti is mentioned if the dosha’s are gambeeragata and the disease is pravruddha (chronic), after shodhana karma, physisian should plan for basti karma. This is because if dosha’s are gambheeragata, then there is a chance that the pravruddha vaata will enter pakvashaya and may cause agnimandya and apakarshana of bala. Hence it is important that basti should be planned in gambheeragata doshas or in pravruddha avastha of disease after shodhana because kaayashodhana will not be able to remove entire dosha’s from body.. The same thing had been clearly mentioned by Bhela in siddhi stana with the verse which goes like this (sloka here)
