The document discusses interfacing between Ayurveda and modern biology in studying arthritis and rheumatism. It outlines the conventional mechanisms of interfacing where biology looks at Ayurveda using modern tools, and Ayurveda looks at biology based on classical texts. The ideal method is proposed where biology answers fundamental Ayurvedic questions to improve understanding, and Ayurveda frames questions for scientific inquiry. Etiologies of arthritis in Ayurveda and modern biology are compared, showing similarities but also need for reappraisal to align descriptions.

1. Clinical and Research
Aspects of Arthritis and
Rheumatism: Ayurveda and
Modern biology Interface
Dr Sanjeev Rastogi
State Ayurveda College, Lucknow University

2. The Idea of The Session
 To devise an appropriate mechanism of synergism between
research in Modern Biology and Ayurveda Biology and to generate
and develop innovative and effective program Applying the
concept of basic science specially modern biology and its tools to
study Ayurvedic System of Medicine
 Recent developments in the field of Autoimmune diseases and
arthritis focusing upon basic research in Modern Biology and
Ayurvedic System of medicine

3. Conventional Mechanism of Interfacing
Biology and Ayurveda
 Biology looking at Ayurveda
 Led by Biologists
 Based upon tools
 Ayurveda Looking at Biology
 Led by Ayurvedic people
 Based upon texts

4. Biology Looking at Ayurveda
 Based upon existing tools of Modern biology to read Ayurveda
 Primarily done by the biologists
 Research questions focus upon the present biological understandings
and the methods are essentially the accepted tools of biology
 Results have been promising but are often markedly inadequate ,
inappropriate and premature
 Do not provide answers to basic questions of Ayurveda
 The process loose the essence of science in ayurveda and
supplements only to the concepts of Biology
 Prepares a groundwork for commercially exploitable knowledge

5. Ayurveda Looking at Biology
 Based upon classical texts of Ayurveda
 Primarily done by Ayurvedic people
 Primarily to bring scientific legitimacy to the principles
and interventions of Ayurveda
 Marked with
 Poorly defined questions
 Poor understanding of tools of research
 Inadequate utilization of research results in practice

6. Impact of Hemi Interfacing
 Biology to Ayurveda
Example of Ashwagandha ( Root or leaves)
Example of Guggulu Research on its hypolipidemic effects
 Ayurveda to Biology
Example of Guggulu Research ( changing properties of old and
new)

7. The ideal method of interfacing
between Biology and Ayurveda
 Role of Biology
 Biology should get ready to answer the basic questions of ayurveda to improve its
understanding of fundamentals and not merely focusing upon the applications of
Ayurveda
 This may be done with the help of existing tools and where needed , new tools
may be designed as per the actual requirement
 Role of Ayurveda
 Ayurveda should get ready to frame its basic questions to be presented before the
scientific community
 The results obtained through such approach may be used to improve the
application of ayurveda

8. Arthritis and Rheumatic Diseases: The
Global Burden
 Canada 15.3%
 United States 21.6%
 United Kingdom 13.0%
 Australia and New Zealand 15.0% to 24.0%
 South American and Caribbean Countries 23.8% to 56.0%
 Globally the prevalence is higher in females and increases with age.
Prevalence of Arthritis and Rheumatic Diseases around the World
A Growing Burden and Implications for Health Care Needs (April 2010)

9. Prevalence of Musculoskeletal Diseases in India
ICMR 2012
Prevalence Total Delhi Dibrugarh Jodhpur
MSD 9.38 7.08 11.52 9.53
1 Spondylo-
arthropathi
es
5.71 4.80 5.76 5.42
2 Osteoarthrit
is
5.20 3.28 5.81 6.52
3 Non Specific
Body ache
and Pain
1.31 0.59 1.61 1.84
4 Soft Tissue
Rheumatism
0.58 0.85 0.77 0.14
5 RA 0.33 0.17 0.19 0.62
6 Gout 0.08 0.13 0.10 0.027

10. Modalities of Management in Arthritis: Indian Scenario
 Malviya AN , Prevalence of Rheumatic Diseases in India : results of a
population survey, JIRA, 1994 (2)1
Type of
Therapy
Population % Duration(
Months)
Response%
Ayurveda 55 4.3 19
Homeopathy 55 3.7 19
Allopathy 51 7 87
Unani 13 3.6 23
Diet 25 6.2 60
Other 20 1.2 28

11. Arthritis and Ayurveda
 A substantial input of arthritis patients in Ayurvedic Hospitals (55%)
 Patients stick to the treatment for considerable period (4.3 months )
 Responses are not optimal (19 %) comparing to responses obtained
through allopathy (87%)
 A serious revisit to ayurvedic understanding of ayurveda is therefore
required

12. Arthritis and Rheumatic Diseases in
Ayurveda
 Arthritis as a primary disease
 Metabolic Arthritic Disease वात रक्त
 Inflammatory Arthritic Disease आम वात
 Degenerative Arthritic Disease संधिवात
 Arthritis as a secondary disease
 Arthritis as a systemic Disease
 Metabolic Arthritic Disease वात रक्त
 Inflammatory Arthritic Disease आम वात
 Arthritis as a localized disease
 Degenerative Arthritic Disease संधिवात
 Local Infection / trauma क्रोष्टुक शीर्ष

13. Ayurvedic knowledge of Arthritis
requiring Biological understanding
 Etiology
 Pathological process
 Treatment modalities
 Prognostic factors
 Preventive proposals

14. Etiology of Arthritis in Ayurveda
• Metabolic causes वात रक्त
 Inflammatory causes आम वात
 Degenerative causes संधिवात

15. Before we interface ??? Beware of the
Contrast
 Ayurvedic disease description has a
convergent approach
 Disease are grouped as per the
clinical features and not as per the
pathology
 Biological disease description has a
divergent approach
 Disease are grouped as per the
pathology and not as per the
clinical features
Common
Cardinal
Sign/
Symptom
Vata
Pathology
Pitta
Pathology
Kapha
Pathology
Common
Pathologies
Diverse
Clinical
Presentation
Diverse
Clinical
Presentation
Diverse
Clinical
Presentation

16. Interfacing on Face Value may be
Misleading
• वात रक्त
• A diverse group of
symptoms involving joints
and soft tissue
 आम वात
 A diverse group of symptoms not limited
to joints as specified to Rheumatoid
Arthritis
 संधिवात
 Joints are not specified . Only generic
features of pain during movement of
joints are described
 Gout
 Rheumatoid Arthritis
 Osteoarthritis

17. For The Purpose of Practical Interfacing
‘Inclusive of but is not limited to’
 Ayurvedic disease description may be considered more comprehensive
than its modern parallel and is inclusive of its modern parallel
• वात रक्त therefore is inclusive of Gout but may not be limited to gout
 आम वात is inclusive of Rheumatoid Arthritis but may not be limited
to RA

18. वात रक्त Pathogenesis
 Gradual involvement of रक्त and वात at two stages
 1st stage : रक्त dushti
 अभिघातादशुद्िया च प्रदुष्टे शोणिते नृिाम॥
 Trauma or inadequate detoxification of body causes a रक्त dushti
 2nd stage : वात dushti
 वायुर्वषवृद्िो वृद्िेन रक्तेन वाररत: पधि ॥
 कृ त्स्नं संदूष्येद रक्तं तज्ज्ञेयं वातशोणितम।
 For these reason वात increases and vitiates and obstructs the
passage of रक्त

19. Gout Pathogeneis
Urate Level
Urate Super
saturation and
Crystallization
Gout
Dietary Purine
Load
Endogenous
Purine Synthesis
Renal
Excretion
Gut Excretion

20. Gout Pathogenesis
 Hyperuriceamia is the necessary precursor of Gout but Clinical Gout
develops in less than 25% of people having hyperuricemia
प्रायश: सुकु मारािाम भमष्ठान्न सुख िोजिनाम ॥
अचन्क्रमिशीलानाम कु प्यते वात्सशोणितम।
 Because of some reason not clearly known, urate crystals precipitate in
and around the joints, are ingested by monocytes and synoviocytes- and
precipitates Acute Gout.
 Two Important points of Intervention
 The factors causing hyperuricemia
 The factors causing precipitation of urate crystals

21. वात रक्त ननदान Etiology
 लविाम्ल कटु क्षार ज्नग्िोष्िािीिष िोिनै:। जक्लन्न शुष्काम्बुिानूप मांसर्पण्याक
मूलकै :॥
 कु लत्सिमार्ननष्पाव शाकादद पललेक्षुभि:। दध्यानाषल सौवीर शुक्ततक्र सुरासवै :॥
 र्वरुद्िाध्यशन क्रोि ददव्वप्न प्रिागरै:। प्रायश: सुकु मारािाम भमष्ठान्न सुख
िोजिनाम ॥
 अचन्क्रमिशीलानाम कु प्यते वात्सशोणितम।
Factors causing रक्त dushti
Resemble to the factors causing Hyperuricemia

22. वात रक्त ननदान
 Food Combination र्वरुद्ि,
 Food intake method अध्यशन , अिीिष िोिन,
 High protein food अम्बुि आनूप मांस, र्पण्याक, कु लत्सि , मार्, ननष्पाव, शाक, पलल, दधि,
 Special food लवि, अम्ल, कटु, क्षार, ज्नग्ि, उष्ि , जक्लन्न, शुष्क, मूलक,
 High sugar intake इक्षु, भमष्ठान्न
 Alcohol / fermented food आरनाल,सौवीर, शुक्त, तक्र, सुरा, आसव, दधि,
 Life style ददवा्वप्न, प्रिागरि, अचंक्रमि शील
 Proneness in सुकु मार, सुख िोिी,
 Emotional factors क्रोि,

23. Etiology of Gout: High Protein Food
 Historically, gout has long been linked with a rich lifestyle involving excesses of meat and
alcohol
 Adhya vata , a disease of riches
 The relative risk of gout is higher in people who eat a high red meat diet (Data from the large
Health Professionals Follow-up Study (HPFS))
 पलल (minced meat)
 Consumption of seafood is associated with a significant, increase in risk.
 अम्बुि आनूप मांस( meat of organisms living in water )
 Diets high in purine-rich vegetables did not increase the risk, while diets high in low-fat dairy
products were associated with reduced risk
 No mention of vegetables / plant proteins
 मूलक , र्पण्याक (sesame flakes), कु लत्सि (Dolicos Biflorus) , मार्( Black gram), ननष्पाव शाक( Bean)

24. Etiology of Gout: Alcohol
 Some alcoholic drinks are rich in purines, notably beer which contains
guanosine.
 Alcohol is though to increase the risk of gout because the metabolism of
ethanol to acetyl CoA leads to adenine nucleotide degradation, resulting in
increased formation of adenosine monophosphate ( AMP), a precursor of UA.
 Alcohol also raises the lactic acid level in blood, which inhibits UA excretion.
 Differences in risk were observed with different alcoholic drinks. Beer had
the greatest effect, because of its high purine (guanosine) content, whereas
wine had no increased risk (Choi et al., 2004).
 आरनाल( Barley Beer),सौवीर( Barley Beer ), सुरा( Rice Beer), आसव

25. Etiology of Gout : Having a Sweet Tooth
 Fructose intake is found associated with increasing risk of gout among
men ( Choi 2007, BMJ)
 Fructose is unique among sugars by its ability to rapidly deplete ATP,
with resultant purine nucleotide degradation and eventual UA
generation
 Sucrose( cane sugar) is a disaccharide composed of glucose and
fructose
 इक्षु( cane sugar), भमष्ठान्न

26. वात रक्त ननदान Requiring A Reappraisal
 Food Combination र्वरुद्ि,
 Food intake method अध्यशन , अिीिष िोिन,
 High protein food र्पण्याक, कु लत्सि , मार्, ननष्पाव शाक,दधि,
 Special food लवि, अम्ल, कटु, क्षार, ज्नग्ि, उष्ि , जक्लन्न, शुष्क, मूलक,
 High sugar intake इक्षु, भमष्ठान्न
 Fermented food शुक्त, तक्र, दधि,
 Life style ददवा्वप्न, प्रिागरि, अचंक्रमि शील
 Proneness in सुकु मार, सुख िोिी,
 Emotional factors क्रोि,
 Quantitative , qualitative and mechanistic understanding of etiologies in वात रक्त may be helpful in
disease prevention

27. वात रक्त ननदान : Requiring A Reappraisal
 Uric acid is a weak acid (pKa, 5.8) that exists largely as urate, the ionized form, at
physiologic pH.
 As urate concentration increases in physiologic fluids, the risk for supersaturation
and crystal formation generally increases.
 An alteration in Ph of Body fluid may be responsible for precipitation of Urate
crystals
 लवि, अम्ल, कटु, क्षार
 शुक्त, तक्र, दधि,

28. Risk factors for Hyperuricemia and Gout
प्रायश: सुकु मारािाम भमष्ठान्न सुख िोजिनाम ॥
अचन्क्रमिशीलानाम कु प्यते वात्सशोणितम।
 Susceptibility among Pitta Dominant people ( Fast Metabolisers )
 Sweet intake
 Leisure eating
 Lack of Exercise
 Increased adiposity and the insulin resistance syndrome are both associated with
hyperuricemia
 Gout and hyperuricaemia are associated with hypertension, diabetes mellitus, metabolic syndrome,
and renal and cardiovascular diseases.
 Similar risk factors are described in context of Prameha in Ayurveda which is also similar to
Metabolic Syndrome

29. वात रक्त : Precipitating factors
अभिघाताद शुद्िया च प्रदुष्टे शोणिते नृिाम॥
कर्ाय कटु नतक्ताल्प रुक्ष आहाराद अिोिनात। हयोष्रयानयानाम्बु क्रीडा
प्लवन लंघनै:॥
उष्िे च अत्सयिष अध्व र्वर्म्याद््यवायाद्वेग ननग्रहात ।
वायुर्वषवृद्िो वृद्िेन रक्तेन वाररत: पधि ॥
कृ त्स्नं संदूष्येद रक्तं तज्ज्ञेयं वातशोणितम।

30. वात रक्त: Precipitating Factors
 अभिघाताद Trauma
 कर्ाय कटु नतक्ताल्प रुक्ष आहाराद अिोिनात
 Prolonged fasting / Starvation
 Promots Gluconeogenesis which adds to purine production
 हयोष्रयानयानाम्बु क्रीडा प्लवन लंघनै:॥
 Riding on some specialized vehicles ( Horse , Camel)
 Swimming/ water sports
 May lead to some lower joint related local changes ( hydration, Ph, Temp. etc)
 उष्िे च अत्सयिष अध्व र्वर्म्याद््यवायाद्वेग ननग्रहात
 More walking during Hot weather: factors leading to dehydration
 About 2/3rd Urate is extreted through renal pathway
 द्वेग ननग्रहात may increase reanl reabsorption of Urate
 वायुर्वषवृद्िो वृद्िेन रक्तेन वाररत: पधि ॥कृ त्स्नं संदूष्येद रक्तं तज्ज्ञेयं वातशोणितम।
 In these conditions , increase vaata obliterates the passage of already increased rakta casing
vaata rakta

31. Affliction of वात रक्त with Joints
त्य ्िानम करौ पादावन्गुल्यम सवष सन्िय:।
कृ त्सवा आदौ ह्तपादे तु मूलम देहे र्विावनत॥ च.धच. २९/ १२
 The solubility of urate in joint fluids, is influenced by many local factors in the joint like :
 Temperature, pH, concentration of cations, level of articular dehydration, and the presence of such
nucleating agents as nonaggregated proteoglycans, insoluble collagens, and chondroitin sulfate.
 Furthermore, these factors may explain the predilection of gout in the first metatarsal phalangeal
joint (a peripheral joint with a lower temperature) and osteoarthritic joints (degenerative joints
with nucleating debris) and the nocturnal onset of pain (because of intra-articular dehydration)
पवष्वभिहतम क्षुब्िम वक्रत्सवादवनतष्ठते। ज्ितम र्पत्तदद संसृष्टम ता्ता सृिनत वेदना:॥

32. वात रक्त पूवष रूप
्वेदोत्सयिष: न वा कार्षण्य ्पशाषञत्सवम क्षते अनतरुक ।
सजन्िशैधिल्यम आल्यम सदनम र्पडकोद्गम:॥
िानुिन्घोरुकट्यम सह्तपादांगसजन्िर्ु। नन्तोद: ्फु रिम िेदो गुरुत्सवम सुजप्तरेव च। कन्डू: सजन्िर्ु
रुग्िूत्सवा िूत्सवा नश्यनत चासकृ त। वैवण्यष मन्डलोत्सपर्त्तवाषतासृक पूवष लक्षिम ॥

33. वात रक्त पूवष रूप
 Features related with joints
 सजन्िशैधिल्यम laxity of joints
 र्पडकोद्गम: Gouty tophi
 सजन्िर्ु नन्तोद: ्फु रिम िेदो Piercing pain in joints
 कन्डू: सजन्िर्ु Itching in Joints
 रुग्िूत्सवा िूत्सवा नश्यनत emerging and vanishing pain
 Generalized features
 ्वेदोत्सयिष: न वा Increased or decreased sweating
 कार्षण्य Black Discoloration
 ्पशाषञत्सवम Loss of sensation
 क्षते अनतरुक Hyper sensation at site of trauma
 आल्यम सदनम Fatigue
 िानुिन्घोरुकट्यम सह्तपादांगसजन्िर्ु। नन्तोद: ्फु रिम िेदो गुरुत्सवम सुजप्तरेव च।
 वैवण्यष मन्डलोत्सपर्त्त Discolouration and development of macules / pappules

34. Types of वात रक्त
 उत्तान भेद Superficial Stage of Acute Gout
कन्डूदाहरुगायाम तोद ्फु रि कु न्चनै :। अजन्वता श्यावरक्ता त्सवग्बाहे ताम्रा तिेष्यते॥ च.धच.२९/२०
 गम्भीर Deep Stage of Advanced Gout
गम्िीरे श्वयिु: ्तब्ि: कदठनोअन्तिृषशानतषमान। श्याव्ताम्रोअिवा दाहतोद ्फु रि पाकवान॥ च.धच.२९/२१
Advanced gout. If crystal deposits continue to accumulate, patient may develop chronically stiff and
swollen joints. This is the advanced stage of gout and is relatively uncommon.
 मिश्रित Mixed stage of recurrent attacks of Gout
रुगर्वदाहाजन्वतो अिीक्ष्िम वायु: सन्ध्यज्िमज्ज्िसु। निन्दजन्नव चरत्सयन्तवषक्री कु वषश्च वेगवान ॥
करोनत खन्िं पन्गुं वा शरीरे सवषतश्चरन । सवैभलन्गैश्च र्वञेयम वातसृग उियाधितम ।

35. वात रक्त उपद्रव
 अ्वप्न अरोचक श्वास मांस कोि भशरोग्रहा:। मूिाष मद रुक तृष्िा ज्ज्वर मोह प्रवेकपा:॥
 दहक्का पांगुल्य र्वसपष पाक तोद भ्रम क्लमा:। अंगुभलवक्रता ्फोटा दाह ममष ग्रहा अबुषदा:॥
 Joint complications
 मांस कोि, पाक, अंगुभलवक्रता, ्फोटा, पांगुल्य
 Cardiovascular and Respiratory Complications
 श्वास, भशरोग्रहा:, मूिाष, मद, मोह, दहक्का, भ्रम

36. “Gangrenous Finger” Proven to be Acute
Gout  Eric Gallagher, and Todd Ruiter, Eplasty. 2015; 15: ic29.
 A 64-year-old woman was transferred from an outlying facility with
a diagnosis of a “gangrenous finger.” She complained of 1 week of
worsening left small finger pain, erythema, and swelling.
Aspiration was performed upon transfer, and she received a
diagnosis of acute gout. Oral colchicine and prednisone were
begun with great improvement.
 Go to:

37. Gout : Possible Complications
 Serum uric acid value is closely associated with hypertension in hyperuricemic
patients
 Hyperuricemia associated with urate deposit has been identified as a risk factor for
ischaemic heart disease, stroke, peripheral artheriopathy and renal failure.
 Gout is a risk factor of cancer, particularly that of urological cancers, digestive
system cancers, and lung cancer. The pooled data further support the hypothesis of
a link between gout and carcinogenesis.
 Weijie Wang et al, Mediators of Inflammation, Volume 2015 (2015), Article ID 680853,
http://dx.doi.org/10.1155/2015/680853

38. वात रक्त उपद्रव
 As described in ayurveda present a natural hisory of
disease . If वात रक्त remains untreated , it may lead to
these complications .
 Hyperuricemia is also considered as a systemic disorder
with initial affliction to joints but leading to organic
damage gradually

39. Treatment of वात रक्त
 Primary therapy :
 Blood letting by Leech, venesection , shring , Tumbi
 Principle of management :
र्वरेच्य: ्नेहनयत्सवादौ ्नेह्युक्ते र्वरेचनै:। रुक्षैवाष मृदुभि: श्तमसकृ द्वज्त कमष च
॥
 Repeated purgation and vasti
सेकाभ्यन्गप्रदेहान्न््नेहा: प्रायो अर्वदादहन: वातरक्ते प्रश्यन्ते ।
 Local application of non irritant substances

40. Treatment of वात रक्त: New Insights
 Decreased extra-renal urate excretion is a common cause of
hyperuricemia
Kimiyoshi et al , Nature Communications Published 03 April 2012
 Extra-Renal Elimination of Uric Acid via Intestinal Efflux Transporter
BCRP/ABCG2
Atsushi Hosomi et al , February 10, 2012DOI:
10.1371/journal.pone.0030456
 Intestinal pathway of urate excretion is important
 Repeated Virechana and Vasti recommendation of Ayurveda may be an
attempt to increase intestinal elimination of Urate pool

41. Treatment of वात रक्त: Drug Therapy
 Extensive use of ghrita, taila , vasa and majja
 Madhuyashti Glycerhiza glabra
 Guduchi Tinospora cardifolia
 Dashamula Ten roots
 Triphala Three fruits

42. Summary
 Modern description of Gout is in tune to Ayurvedic description of vaatarakta with some additional information
available in Ayurveda
 Rakta vitaters : High purine diet
 Vaata vitaiters : Factors promoting the precipitation of urate crystals in and around the joints
 Proneness: people having sweet tooth, easy going people , Metabolic syndrome
 Treatment
 Blood letting : a direct mean of reducing the urate load
 Virecahan and Vasti to increase intestinal elimination of Urate
 Avoidance of causative factors
 to avoid purine overload
 to avoid renal shut down by avoiding factors causing dehaydration
 To avoid renal reuptake of urate by avoiding द्वेग ननग्रहात
 An early management may prevent complications and can assure a better prognosis

43. वात रक्त : Leads from Ayurveda for
Their Biological Exploration
 Susceptibility
 Etiological factors
 Precipitating factors
 Clinical features
 Local and systemic complications
 Prognostic factors
 Preventive measures
 Acute management
 Long term management