The document discusses approaches to treating rheumatoid arthritis from an Ayurvedic perspective. It explores comparing RA to Ayurvedic disease states like Vata Rakta and selecting relevant medicines. It also emphasizes analyzing each condition based on its subtle nuances rather than rigid categorization. The document outlines diagnostic criteria for RA and reviews potential Ayurvedic treatment approaches including herbal formulations, individual herbs, and following classical texts. It stresses the importance of clinical experience and flexibility over rigid paradigms.

1. Dr.R.Krishnakumar. MD(Ay)
Medical Officer
Govt .Ayurveda Dispensary ,
Vallikunnam

2. SELECTION OF YOGAS
w.s.r
RHEUMATOLOGY

3. CSM model of drug selection in the
Ayurvedic Management of
Rheumatologic conditions
 Howard Leventhal introduced the common
sense model (CSM) of self regulation of health
and Illness.
 The CSM concept is adopted here in principle
, the term common sense refers to adherence
to basic principles of Ayurveda in simple
straight forward way, rather than hair splitting
juggleries .

4. Rheumatology
The term refers to branch of
medicine that which deals with the
medical disorders of the musculo-
skeletal system.

5. Rheumatology = Confusion
 Rheumatoid arthritis = ? Vātarakta / Āmavāta
 Āmavāta = Rheumatic fever ???????
 Comparisons and Confusion ?????????

6. Concept of disease in routine
ayurvedic clinical practice ……….
कः पुनरसौ रोग इति । ऄवस्थातवतिष्टो दोषः।
नरतसंहभाष्यम्.१-१
kaḥ punarasau roga iti. avasthāviśiṣṭo
doṣaḥ.
narasiṁhabhāṣyam. 1-1

7. बुद्ध्वा स्थानतविेषांश्च दोषाणां च बलाबलम् ।
तचतकतससितमदं कुयाादूहापोहतवकल्पतवि् ॥
चरकसंतहिा तचतकससास्थानम् २९-१५५

8. Message from Caraka for
Dravyaguṇa experts
मात्राकालाश्रया युतिः तसतियुािौ प्रतितष्ििा ।
तिष्िसयुपरर युतिज्ञो द्रव्यज्ञानविां सदा ॥
चरक संतहिा सूत्रस्थानम् २-१६

9. Line of treatment………………
न युक्तमवधारणममदमेव प्रधानममदं नेमि
मिमित्सायां मह प्रधानमवस्थानुमवधानम ्।
R.V.Su.१-९३

10. PHARMACEUTICAL PARADIGM
VERSUS
THERAPEUTIC PARADIGM
PHARMACEUTICALISATION OF AYURVEDA
coinage by Dr.Madhulika Banerjee.
Dr.Harilal Madhavan puts forth a very relevant
question for us : the future of therapeutic āyurveda

11. Rheumatology and Ayurveda
Daniel E Furst, Manorama M Venkatraman, B G
Krishna Swamy, P.Rammanohar et al
“Well controlled, double-blind, placebo-controlled
trials of classical Ayurvedic treatment are possible
in rheumatoid arthritis”
The major strength of this study was that the
Ayurvedic doctor was free to individualize treatment.

12. Rheumatoid arthritis
Diagnostic criteria
At least four of the following criteria should be present for the
diagnosis of rheumatoid arthritis:
 Morning stiffness for ≥ 1 hour
 Arthritis of ≥ 3 joints
 Arthritis of hand joints (wrist, metacarpo-phalangeal joints or
proximal interphalangeal joints)
 Symmetric arthritis
 Rheumatoid nodules
 Positive serum rheumatoid factor. (Anti citrullinated peptide [ anti-
CCP] andtibodies have high specificity and sensitivity for RA.)
 Radiographic changes

13.  The methodologies for research and evaluation
of traditional medicine should be based on the
following basic principles.
 On the one hand, the methodologies should
guarantee the safety and efficacy of herbal
medicines and traditional procedure-based
therapies.
 On the other hand, however, they should not
become obstacles to the application and
development of traditional medicine. This
complex issue has been a concern for national
health authorities and scientists in recent years.
(p.2 Guidelines for methodologies on research
and evaluation of traditional medicine,WHO, 2000)

14. Ayurvedic Approaches to RA
1) Compare this to any of the Ayurvedic disease
state and randomly select medicines indicated for
that .(vyādhijnama hetu saṃprāpti)
2) Analyze the condition without ignoring its subtler
nuances. (dosetikartavyatarūpa saṃprāpti). This
approach is followed by most of the traditional
vaidyas of Kerala.

15. Vātarakta model
vāyurvivr̥ddho vr̥ddhena raktenāvāritaḥ
pathi.
kruddhaḥ sa dūṣayedraktaṃ taṃ jñeyaṃ
vātaśoṇitaṃ. Cikitsāmañjari .1
kṣipraṃ raktaṃ duṣṭimāyāti tacca vāyor
mārgaṃ saṃruṇddhyāśu……S.S.Ni.1.43

16. ऄमृिा संग्राहणीय दीपनीय वािश्लेष्म
िोतणितवबन्धप्रिमनानाम् । A.S.Su
ऄमृिा संग्रातहक वािहर दीपनीय श्लेष्म
िोतणितवबन्धप्रिमनानम्। c.s.
गुडूची वािास्रे । A.H
तवबन्धः स्रोिोतभभूािानामवहनम् ।

17. Stage which requires Pāncana
ऄमृिानागरधान्याककषात्रयेण पाचनं तसिम् ।
जयति सरिं वािं सामं कुष्िान्यिेषातण ॥ चक्रदत्तम्-३
ṣaḍaṃgaṃ cukku kūṭṭāte sāmr̥taṃ pibatāṃ
nr̥ṇāṃ.
panikkuṃ vātaraktatte ttaṭukkuṃ
novumillayāṃ . Cikitsāmañjari. 16
Aṣṭavaidya tradition ṣaḍdharaṇacūraṇa modified as
citrakādi kvātha

18. Two yogas……………….
śatāvarī chinnaruha amalatvak balekṣu rāsnāvihita
kaṣāyaḥ.
dugdhena vātāsravikāra śāntyai martyena peyaśca
tatha aṅgamardde.
śatāvarī chinnaruha amalatvak balekṣukāṇḍekṣura
saṃbhr̥tāṃbhaḥ.
kalkena yaṣṭīmadhukasya miśraṃ dhunoti
vātāśramathāśrapittaṃ

19. balā nālamr̥tā ṣaḍ ca dāru raṇḍu kazñcumāyi.
sapāl kaṣāyaṃ pātavyaṃ vātarakta aṅgamarddajit.
Cikitsāmañjari.17

20. Rāsnairandādi kaṣāyam
 Vaṅgasena
Sahasrayoga

21. Single drugs
Duḍūcī :
kātu, tiktā, madhuravipāka,
rasāyanā, saṃgrāhiṇī, kaṣāya, uṣṇa,
laghu, balya, agnidīpani, tridoṣahara,
amahara, tr̥ṣṇahara, mehahara,
kāsahara, kāmala paṇḍuharaṃ,
kuṣṭhahara, kr̥mihara, vātāraktahara,
jvarahara, vāmihara.

22.  Haritaki:
uṣṇa,laghu,br̥haṃana, anulomana, kaṣāya,
rūkṣa, medhya, dīpana, sarā, madhura vipāka,
rasāyani, cakṣuṣya, srotovibandhahara,
śvāsa,kāsa,prameha, arśas, kuṣṭha, śopha,
udara, kr̥mi, vaisvarya, grahaṇi, roga,
vibandha, viṣmajvara, gulma, ādhmana
haritakī jayet vyādhīṃstāstāśca kaphavātajān
sarveṣu ca guḍaharītakīmāseveta

23.  Bodhivr̥kṣa : durjara,hima, rukṣa, pittahara
ślesmahara, vr̥ṇahara, asrahara, guru, kaṣaya
rasa,varṇya, yoniviśodhana.
 Kokilakṣa: śītala, vr̥ṣya, madhura,amla,
picchila, tikta, śophahara, āmahara,
vātahara, tr̥ṣṇahara, netrarogajit,
vātaraktahara.

24. guḍūcī vā yathā tathā
guḍa harītakī
pippalī vardhamānaṃ

25. स्मृमिमान ्हेिुयुमक्तज्ञो मििात्मप्रमिऩमिमान ्।
मिषगौषधसंयोगैमिमित्सां ििुुमहुमि॥ ि-सं-सू- २-३६
smṛtimān hetuyuktijño jitātmapratipattimān|
bhiṣagauṣadhasaṁyogaiścikitsāṁ
kartumarhati|| ca-saṁ-sū- 2-36
śubhaṃ